from the more actually extends Marti-Bonmati
proximal portion of the left main portal vein more cephalad into segment 2. We thank Dr for correcting this oversight.
Rendon C. Nelson, MD,* Judith Douglas R. Murray, MD,t and
L. Chezmar, MD,* Michael E. Bernardino,
Departments
Surgery,t
of Radiobogy*
and
School of Medicine 1364 Clifton Road NE, Atlanta,
Emory
MD*
University
GA 30322
Paul H. Sugarbaker, MD Washington Hospital Center, Cancer Institute 1 10 Irving Street NW, Washington, DC
U Mixed in Breast
Form, Cancer
Diffusely Scattered Calcifications with Apocrine Features
From: Marc
J. Homer,
Departments
MD,*
and
Homa
of Radiology*
Medical Center Medicine 750 Washington
Safaii,
and
Hospitals, Street,
MDt
Pathobogy,t
Tufts
Boston,
New
University
MA
England
School
of
12111
Editor: We read with great interest the excellent article by Kopans et al (1), which appeared in the December 1990 issue of Radiology. In it they report 10 women with extensive breast carcinoma associated with diffusely scattered calcifications. These calcifications had a wild, chaotic appearance and included benign forms such as milk of calcium. Histologic correlations revealed infiltrating and intraductal carcinoma with prominent apocnine
features.
We
recently
described
a strikingly
similar
case of a large, nonpalpable area of microcalcifications including milk of calcium forms (2). Biopsy revealed extensive carcinoma, and our review of the histologic specimen, after reading of the observations of Kopans et al, revealed aprocnine features.
The
message
of their
article
is important
and
References Kopans scattered diology
DB, Nguyen PL, Koerner calcifications in breast 1990; 177:807-811.
2.
Homer MJ. Mammographic New York: McGraw-Hill,
3,
Sickles EA, Abele cysts. Radiology
JS. 1981;
U
Stereotactic
Breast
FC, et al. cancer with
interpretation:
1991; 207-208. Milk of calcium within 141:655-658.
Biopsy
with
Mixed form, diffusely apocrine features. Ra-
a practical tiny
benign
a Biopsy
approach. breast
Gun
From: J. Jaeger, MD, FRCS,* Gabriele H. Kruegener, John MacFie, MD, FRCS,* and Ian Glaves, FRCRt Departments of Surgery* and Radiobogy,t Scarborough Hospital Scarborough, North Yorkshire, England Y012 6QL Horst
We read with interest the article by Parker et al in the September 1990 issue of Radiology (1) on the use of the Biopty gun (distributed by Bard Urobogical, Covington, Ga; manufactured by Radioplast, Uppsala, Sweden) for stereotactic breast biopsy. We have used the Biopty gun in performing ultrasound (US)-guided needle core biopsies of the pancreas (2) and abdominal masses (3), and, recently, we have started to use it for breast biopsies. We perform the entire procedure under simultaneous US
a
Radiology
when
guidance
the
lesion
can
in
percutaneous
be visualized
needle
breast
biop-
at US.
References 1. Parker SH, Lovin JD, Jobe WE, et al. Steneotactic breast biopsy with a biopsy gun. Radiology 1990; 176:741-747. 2. Mitchell CJ, Wai D, Jackson AM, MacFie J. Ultrasound guided percutaneous pancreatic biopsy. Br J Sung 1989; 76:706-707. 3.
Jaeger
HJ, MacFie
J, Mitchell
CJ, Couse
abdominal masses with percutaneous sound.BrMedJ 1990; 301:1188-1191.
N, Wai D. biopsy
guided
Diagnosis
of
by ultra-
Errata “The Non-Hodgkin Lymphomas: Practical Concepts for the Diagnostic Radiologist.” Radiology 1991; 178:315-321. Page 319, third column, second sentence under Chest should be inserted as follows: One study suggests that routinely obtamed chest CT scans are of value in patients with NHL (Radiology 1986; 158:659-662). Page 320, first column, last sentence should read as follows: “Patients with diffuse architecture NHL (or, for that matter, HD or other tumors) with subdiaphragmatic lymphadenopathy usually show regional lymph node disease with sparing of other lymph node sites; or if all lymph node groups are involved, certain groups are more extensively involved than others. Page 321, Addendum, reference cited should read Cancer 1990; 66:530-536.
MD,*
Editor:
586
mammographic
sies
should
be understood by every radiologist performing mammography. As has been noted by Sickles and Abele (3), unless every calcification conforms to milk of calcium, one cannot automatically assume that an area of microcalcifications, even if it is extensive and nonpalpable, is benign.
1.
scanning. The method we use is as follows: First, the lesion is visualized at US, then the tip of the Tnt-cut needle (Radiplast AB, Sweden) mounted in the Biopty gun is positioned at the edge of the lesion through a skin nick. The gun is fired, and the needle can be seen advancing into the lesion on the US images. Four biopsies are normally performed-one for each quadrant of the lesion. We have performed US-guided biopsy of breast lesions in 43 consecutive patients, seven of whom had no palpable abnormality. Sufficient tissue for histologic assessment was not obtained in three patients, all of whom had nonpalpable lesions and microcalcifications only identified at mammography. In all the remaining patients, sufficient tissue was obtamed for satisfactory histologic examination. Parker et al have encountered the problem that patient movement and/or displacement of a mobile lesion shortly before and during the stereotactic biopsy leads to-failure to sample the correct site. Our experience is that US guidance helps avoid this problem because it allows constant adjustment of the position of the biopsy needle up to the time the gun is fired and enables monitoring of the actual biopsy procedure and confirmation of the biopsy site after the procedure. This, together with the possibility of performing true “four-quadrant” sampling, helps achieve maximum accuracy in biopsy of palpable and nonpalpable breast lesions. We believe that US guidance may be superior to stereotactic
“Assassins and port.” Radiology Table 1, columns
Zealots: Variations in Peer Review. 1991; 178:637-642. 1 and 2 should read as follows:
Zealot Pushover Mainstream Demoter Assassin The distribution shown in Figure
Special
>2.5
SD
below
mean
>1.5
SD
below
mean
Re-
Mean ± 1.5 SD > 1 .5 SD above mean >2.5
of the 2.
reviewers
SD
by category
above
mean
is correctly
May
1991
proximal portion of the left main portal vein more cephalad into segment 2. We thank Dr for correcting this oversight.
Rendon C. Nelson, MD,* Judith Douglas R. Murray, MD,t and
L. Chezmar, MD,* Michael E. Bernardino,
Departments
Surgery,t
of Radiobogy*
and
School of Medicine 1364 Clifton Road NE, Atlanta,
Emory
MD*
University
GA 30322
Paul H. Sugarbaker, MD Washington Hospital Center, Cancer Institute 1 10 Irving Street NW, Washington, DC
U Mixed in Breast
Form, Cancer
Diffusely Scattered Calcifications with Apocrine Features
From: Marc
J. Homer,
Departments
MD,*
and
Homa
of Radiology*
Medical Center Medicine 750 Washington
Safaii,
and
Hospitals, Street,
MDt
Pathobogy,t
Tufts
Boston,
New
University
MA
England
School
of
12111
Editor: We read with great interest the excellent article by Kopans et al (1), which appeared in the December 1990 issue of Radiology. In it they report 10 women with extensive breast carcinoma associated with diffusely scattered calcifications. These calcifications had a wild, chaotic appearance and included benign forms such as milk of calcium. Histologic correlations revealed infiltrating and intraductal carcinoma with prominent apocnine
features.
We
recently
described
a strikingly
similar
case of a large, nonpalpable area of microcalcifications including milk of calcium forms (2). Biopsy revealed extensive carcinoma, and our review of the histologic specimen, after reading of the observations of Kopans et al, revealed aprocnine features.
The
message
of their
article
is important
and
References Kopans scattered diology
DB, Nguyen PL, Koerner calcifications in breast 1990; 177:807-811.
2.
Homer MJ. Mammographic New York: McGraw-Hill,
3,
Sickles EA, Abele cysts. Radiology
JS. 1981;
U
Stereotactic
Breast
FC, et al. cancer with
interpretation:
1991; 207-208. Milk of calcium within 141:655-658.
Biopsy
with
Mixed form, diffusely apocrine features. Ra-
a practical tiny
benign
a Biopsy
approach. breast
Gun
From: J. Jaeger, MD, FRCS,* Gabriele H. Kruegener, John MacFie, MD, FRCS,* and Ian Glaves, FRCRt Departments of Surgery* and Radiobogy,t Scarborough Hospital Scarborough, North Yorkshire, England Y012 6QL Horst
We read with interest the article by Parker et al in the September 1990 issue of Radiology (1) on the use of the Biopty gun (distributed by Bard Urobogical, Covington, Ga; manufactured by Radioplast, Uppsala, Sweden) for stereotactic breast biopsy. We have used the Biopty gun in performing ultrasound (US)-guided needle core biopsies of the pancreas (2) and abdominal masses (3), and, recently, we have started to use it for breast biopsies. We perform the entire procedure under simultaneous US
a
Radiology
when
guidance
the
lesion
can
in
percutaneous
be visualized
needle
breast
biop-
at US.
References 1. Parker SH, Lovin JD, Jobe WE, et al. Steneotactic breast biopsy with a biopsy gun. Radiology 1990; 176:741-747. 2. Mitchell CJ, Wai D, Jackson AM, MacFie J. Ultrasound guided percutaneous pancreatic biopsy. Br J Sung 1989; 76:706-707. 3.
Jaeger
HJ, MacFie
J, Mitchell
CJ, Couse
abdominal masses with percutaneous sound.BrMedJ 1990; 301:1188-1191.
N, Wai D. biopsy
guided
Diagnosis
of
by ultra-
Errata “The Non-Hodgkin Lymphomas: Practical Concepts for the Diagnostic Radiologist.” Radiology 1991; 178:315-321. Page 319, third column, second sentence under Chest should be inserted as follows: One study suggests that routinely obtamed chest CT scans are of value in patients with NHL (Radiology 1986; 158:659-662). Page 320, first column, last sentence should read as follows: “Patients with diffuse architecture NHL (or, for that matter, HD or other tumors) with subdiaphragmatic lymphadenopathy usually show regional lymph node disease with sparing of other lymph node sites; or if all lymph node groups are involved, certain groups are more extensively involved than others. Page 321, Addendum, reference cited should read Cancer 1990; 66:530-536.
MD,*
Editor:
586
mammographic
sies
should
be understood by every radiologist performing mammography. As has been noted by Sickles and Abele (3), unless every calcification conforms to milk of calcium, one cannot automatically assume that an area of microcalcifications, even if it is extensive and nonpalpable, is benign.
1.
scanning. The method we use is as follows: First, the lesion is visualized at US, then the tip of the Tnt-cut needle (Radiplast AB, Sweden) mounted in the Biopty gun is positioned at the edge of the lesion through a skin nick. The gun is fired, and the needle can be seen advancing into the lesion on the US images. Four biopsies are normally performed-one for each quadrant of the lesion. We have performed US-guided biopsy of breast lesions in 43 consecutive patients, seven of whom had no palpable abnormality. Sufficient tissue for histologic assessment was not obtained in three patients, all of whom had nonpalpable lesions and microcalcifications only identified at mammography. In all the remaining patients, sufficient tissue was obtamed for satisfactory histologic examination. Parker et al have encountered the problem that patient movement and/or displacement of a mobile lesion shortly before and during the stereotactic biopsy leads to-failure to sample the correct site. Our experience is that US guidance helps avoid this problem because it allows constant adjustment of the position of the biopsy needle up to the time the gun is fired and enables monitoring of the actual biopsy procedure and confirmation of the biopsy site after the procedure. This, together with the possibility of performing true “four-quadrant” sampling, helps achieve maximum accuracy in biopsy of palpable and nonpalpable breast lesions. We believe that US guidance may be superior to stereotactic
“Assassins and port.” Radiology Table 1, columns
Zealots: Variations in Peer Review. 1991; 178:637-642. 1 and 2 should read as follows:
Zealot Pushover Mainstream Demoter Assassin The distribution shown in Figure
Special
>2.5
SD
below
mean
>1.5
SD
below
mean
Re-
Mean ± 1.5 SD > 1 .5 SD above mean >2.5
of the 2.
reviewers
SD
by category
above
mean
is correctly
May
1991
