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A comparison of intravenous and intramuscular buscopan for barium meal examinations
ABSTRACTS These studies show that the Fast SPGR images are of equivalent quality to the existing S P G R sequences. However Fast SPGR enables the whole breast to be imaged, whereas only up to three (pre-selected) slices are possible using SPGR. This is important if the mass cannot be detected on unenhanced images; to detect multiple abnormalities; and to counter misregistration owing to patient movement. It is possible to screen the breast for malignant disease using this technique. MARKER B I O P S Y OF I M P A L P A B L E BREAST LESIONS: A N A U D I T OF 282 P R O C E D U R E S G. M. T U R N E R , A. H I T C H C O C K , A. R. M. WILSON, M. G A L E A , R. W. B L A M E Y , E. J. R O E B U C K , C. W. E L S T O N and I. O. ELLIS
Breast Screening Training Centre, City Hospital, Nottingham An audit of 282 marker localization biopsy procedures (184 screening and 94 symptomatic patients) carried out between 1987 and 1992 is presented. The imaging features have been correlated with the histopathology to produce positive predictive values (PPV) for malignancy. The predominant m a m m o g r a p h i c indications for marker biopsy were microcalcifications (43%; overall PPV 40%; comedo PPV 85%; 'noncomedo' PPV 34%), mass lesion (21%; well-defined (PPV < 0%), poorly defined (PPV 50 %)), spiculate lesion (16%; PPV 91%) and parenchymal deformity (10%; PPV 70%). The introduction of F N A in 1988 significantly increased the specificity of malignant diagnosis (rising from 18% to 56%). The histopathology o f these impalpable lesions was 50 ductal carcinoma in situ (comedo 24; 'non-comedo' 29), three lobular carcinoma in situ, 83 invasive carcinomas (ductal NST 35; tubular 18; tubular mixed 17; lobular 7; other 6), and 146 benign lesions. The success rate for removing the appropriate area for diagnosis and therapy was high (94%). Dissatisfaction with the commercially available marker wires led us to develop a new marker device (The Nottingham Marker Device, Mediplus Ltd). Our experience of 150 Nottingham device localizations will be described (successful removal of marked lesion >96%). S T E R E O T A C T I C A L L Y G U I D E D FINE NEEDLE A S P I R A T I O N C Y T O L O G Y (SFNAC) O F I M P A L P A B L E BREAST LESIONS A VALUABLE DIAGNOSTIC TECHNIQUE? L. J. Y E O M A N , M. J. M I C H E L L , S. H U M P H R E Y S and H. B. N U N N E R L E Y
Breast Assessment Unit and National Training Centre, King's" College Hospital, London S F N A C of impalpable breast lesions is an increasingly available technique. Although it is generally well tolerated by patients it can be a time-consuming and labour-intensive procedure. The purpose of this study was, therefore, to determine the value of S F N A C in the management of patients with non-palpable lesions detected by breast screening mammography. The study group comprised 50 such patients in whom the impalpable m a m m o g r a p h i c abnormalities was graded as either moderately or strongly suspicious of malignancy after full imaging assessment. All patients underwent S F N A C followed by needle localization excision biopsy for histological diagnosis. Eighty-six per cent of the samples were adequate for cytological diagnosis. Cytology was definitely benign in 10 cases. Histology confirmed a benign lesion in nine and showed lobular carcinoma in situ in one. Cytology was definitely malignant in 17 cases with no false negatives. We will discuss how the results of our study have enabled us to change our management practice such that the benign biopsy rate is reduced. If our new policy were to be applied to this study group 18% would be spared unnecessary surgery. We also find a positively malignant S F N A C result useful in enabling planning of surgery and counselling to be undertaken preoperatively. We conclude that S F N A C is a valuable and cost-effective diagnostic tool in the assessment of impalpable m a m m o g r a p h y detected breast lesions. T H E EFFECT O F AN A G G R E S S I V E SFNA P O L I C Y ON T H E M A N A G E M E N T OF M I C R O C A L C I F I C A T I O N D E T E C T E D IN T H E N A T I O N A L BREAST S C R E E N P R O G R A M M E F. J. G I L B E R T , H. A. D E A N S , G. N E E D H A M and M. M c K E A N
Departments of Radiodiagnosis and Cytology, North East of Scotland Breast Screening Programme, Aberdeen The National Breast Screening P r o g r a m m e has increased the n u m b e r of impalpable lesions detected by m a m m o g r a p h y . This has led to an
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increase in the n u m b e r of stereotactic fine needle aspirations performed for cytology prior to or instead of biopsy. In the North East of Scotland (equivalent to one Forrest Unit) from year two of the prevalent round an aggressive S F N A policy was adopted for all impalpable lesions that had a mammographic score of -- 1 or greater. Over a 15 m o n t h period 16 277 women were screened, of w h o m 268 had SFNA. O f these 51 went to open biopsy and 24 cancers were detected. A total of 172 S F N A s were performed for microcalcification, of which 37 went to open biopsy and 18 cancers were detected. O f these 18 cancers, 10 were ductal carcinoma in situ only. During the study period the overall malignant : benign ratio increased from 1.2:1 to 2. i : 1 and the n u m b e r of benign open biopsies fell from 53 to 11 per I000 women screened. In conclusion, an aggressive S F N A policy reduced the number o f open biopsies, increased the confidence of the team in S F N A diagnosis and increased the number of cancers found by detecting cancers (including DCIS) in a low index of suspicion group.
A C O M P A R I S O N OF I N T R A V E N O U S AND I N T R A M U S C U L A R B U S C O P A N FOR B A R I U M MEAL E X A M I N A T I O N S G. T. ABBOTT, H. J. LEWIS-JONES, G. L A M B and N. P. A R C H A R D
Departments' of Radiodiagnosis, Fazakerley and Royal Liverpool Hospitals, Liverpool We performed a prospective study of 108 patients referred for barium meal examination, randomly assigning them to receive 20 m g of buscopan intravenously or intramuscularly. The intravenous group comprised 28 females and 24 males, the intramuscular group comprised 30 females and 26 males. Buscopan was administered after ingestion of an effervescent agent followed by a standard double-contrast barium meal. Before and after the examination patients read a standard reading test type to assess visual acuity. The radiographs were assessed independently by two radiologists and scored according to relaxation, coating and duodenal obscuration of the gastric antrum. Total scores for each observer were added together and the patients were divided into three groups according to their score. Statistical analysis using a modified Z2 test to compare intravenous with intramuscular injection gave a value of 1.67, which is not statistically significant. The incidence of gastro-duodenal pathology in the series was 8.3%. A total of 76.5% of the intravenous group of patients had blurred vision following the examination compared to 12.3% of the intramuscular group. The study demonstrated that in this group of patients, intramuscular administration of buscopan was as effective as intravenous administration for barium meal examinations. This m a y be useful for patients where venous access is difficult or where blood spillage is hazardous.
M R A P P E A R A N C E S OF P U L M O N A R Y ARTERY S A R C O M A G. M. BAXTER, G. M c C R E A T H , R. M I L R O Y , R. S T E P H E N S O N and A. D O R W A R D
Department of Radiology, Southern General Hospital, Glasgow Pulmonary artery sarcomas are rare tumours with only 40 75 cases having been reported in the world literature. The diagnosis of pulmonary artery sarcoma is virtually never considered prior to surgery (pulmonary embolectomy) or autopsy, most of these tumours being diagnosed at post-mortem. It is presumably due to this and to the fact that such patients usually present with signs and symptoms of chronic pulmonary thromboembolism causing clinical confusion that contributes to their dismal prognosis. We have recently diagnosed two cases of pulmonary artery sarcoma prior to post-mortem and surgical confirmation. In both cases ventilation perfnsion scan demonstrated a unilateral perfusion defect with normal ventilation. M R showed a solid mass arising from the main pulmonary artery consistent with t u m o u r in both cases whilst C T scanning showed an intraluminal filling defect in the second case only. Subtotal resection of the t u m o u r was undertaken in the second case but unfortunately the patient died 10 days post-operatively. We will review the literature and both cases of pulmonary artery sarcoma and the contribution of M R imaging to the diagnosis.
TRANSIENT ISCHAEMIA ATTACKS DUE TO MENINGIOMAS E. W. C A M E R O N
Department of Radiology, Charing Cross Hospital, London Transient ischaemic attacks (TIAs) are defined as episodes of focal neurological dysfunction in a specific arterial vascular (carotid or
Breast Screening Training Centre, City Hospital, Nottingham An audit of 282 marker localization biopsy procedures (184 screening and 94 symptomatic patients) carried out between 1987 and 1992 is presented. The imaging features have been correlated with the histopathology to produce positive predictive values (PPV) for malignancy. The predominant m a m m o g r a p h i c indications for marker biopsy were microcalcifications (43%; overall PPV 40%; comedo PPV 85%; 'noncomedo' PPV 34%), mass lesion (21%; well-defined (PPV < 0%), poorly defined (PPV 50 %)), spiculate lesion (16%; PPV 91%) and parenchymal deformity (10%; PPV 70%). The introduction of F N A in 1988 significantly increased the specificity of malignant diagnosis (rising from 18% to 56%). The histopathology o f these impalpable lesions was 50 ductal carcinoma in situ (comedo 24; 'non-comedo' 29), three lobular carcinoma in situ, 83 invasive carcinomas (ductal NST 35; tubular 18; tubular mixed 17; lobular 7; other 6), and 146 benign lesions. The success rate for removing the appropriate area for diagnosis and therapy was high (94%). Dissatisfaction with the commercially available marker wires led us to develop a new marker device (The Nottingham Marker Device, Mediplus Ltd). Our experience of 150 Nottingham device localizations will be described (successful removal of marked lesion >96%). S T E R E O T A C T I C A L L Y G U I D E D FINE NEEDLE A S P I R A T I O N C Y T O L O G Y (SFNAC) O F I M P A L P A B L E BREAST LESIONS A VALUABLE DIAGNOSTIC TECHNIQUE? L. J. Y E O M A N , M. J. M I C H E L L , S. H U M P H R E Y S and H. B. N U N N E R L E Y
Breast Assessment Unit and National Training Centre, King's" College Hospital, London S F N A C of impalpable breast lesions is an increasingly available technique. Although it is generally well tolerated by patients it can be a time-consuming and labour-intensive procedure. The purpose of this study was, therefore, to determine the value of S F N A C in the management of patients with non-palpable lesions detected by breast screening mammography. The study group comprised 50 such patients in whom the impalpable m a m m o g r a p h i c abnormalities was graded as either moderately or strongly suspicious of malignancy after full imaging assessment. All patients underwent S F N A C followed by needle localization excision biopsy for histological diagnosis. Eighty-six per cent of the samples were adequate for cytological diagnosis. Cytology was definitely benign in 10 cases. Histology confirmed a benign lesion in nine and showed lobular carcinoma in situ in one. Cytology was definitely malignant in 17 cases with no false negatives. We will discuss how the results of our study have enabled us to change our management practice such that the benign biopsy rate is reduced. If our new policy were to be applied to this study group 18% would be spared unnecessary surgery. We also find a positively malignant S F N A C result useful in enabling planning of surgery and counselling to be undertaken preoperatively. We conclude that S F N A C is a valuable and cost-effective diagnostic tool in the assessment of impalpable m a m m o g r a p h y detected breast lesions. T H E EFFECT O F AN A G G R E S S I V E SFNA P O L I C Y ON T H E M A N A G E M E N T OF M I C R O C A L C I F I C A T I O N D E T E C T E D IN T H E N A T I O N A L BREAST S C R E E N P R O G R A M M E F. J. G I L B E R T , H. A. D E A N S , G. N E E D H A M and M. M c K E A N
Departments of Radiodiagnosis and Cytology, North East of Scotland Breast Screening Programme, Aberdeen The National Breast Screening P r o g r a m m e has increased the n u m b e r of impalpable lesions detected by m a m m o g r a p h y . This has led to an
433
increase in the n u m b e r of stereotactic fine needle aspirations performed for cytology prior to or instead of biopsy. In the North East of Scotland (equivalent to one Forrest Unit) from year two of the prevalent round an aggressive S F N A policy was adopted for all impalpable lesions that had a mammographic score of -- 1 or greater. Over a 15 m o n t h period 16 277 women were screened, of w h o m 268 had SFNA. O f these 51 went to open biopsy and 24 cancers were detected. A total of 172 S F N A s were performed for microcalcification, of which 37 went to open biopsy and 18 cancers were detected. O f these 18 cancers, 10 were ductal carcinoma in situ only. During the study period the overall malignant : benign ratio increased from 1.2:1 to 2. i : 1 and the n u m b e r of benign open biopsies fell from 53 to 11 per I000 women screened. In conclusion, an aggressive S F N A policy reduced the number o f open biopsies, increased the confidence of the team in S F N A diagnosis and increased the number of cancers found by detecting cancers (including DCIS) in a low index of suspicion group.
A C O M P A R I S O N OF I N T R A V E N O U S AND I N T R A M U S C U L A R B U S C O P A N FOR B A R I U M MEAL E X A M I N A T I O N S G. T. ABBOTT, H. J. LEWIS-JONES, G. L A M B and N. P. A R C H A R D
Departments' of Radiodiagnosis, Fazakerley and Royal Liverpool Hospitals, Liverpool We performed a prospective study of 108 patients referred for barium meal examination, randomly assigning them to receive 20 m g of buscopan intravenously or intramuscularly. The intravenous group comprised 28 females and 24 males, the intramuscular group comprised 30 females and 26 males. Buscopan was administered after ingestion of an effervescent agent followed by a standard double-contrast barium meal. Before and after the examination patients read a standard reading test type to assess visual acuity. The radiographs were assessed independently by two radiologists and scored according to relaxation, coating and duodenal obscuration of the gastric antrum. Total scores for each observer were added together and the patients were divided into three groups according to their score. Statistical analysis using a modified Z2 test to compare intravenous with intramuscular injection gave a value of 1.67, which is not statistically significant. The incidence of gastro-duodenal pathology in the series was 8.3%. A total of 76.5% of the intravenous group of patients had blurred vision following the examination compared to 12.3% of the intramuscular group. The study demonstrated that in this group of patients, intramuscular administration of buscopan was as effective as intravenous administration for barium meal examinations. This m a y be useful for patients where venous access is difficult or where blood spillage is hazardous.
M R A P P E A R A N C E S OF P U L M O N A R Y ARTERY S A R C O M A G. M. BAXTER, G. M c C R E A T H , R. M I L R O Y , R. S T E P H E N S O N and A. D O R W A R D
Department of Radiology, Southern General Hospital, Glasgow Pulmonary artery sarcomas are rare tumours with only 40 75 cases having been reported in the world literature. The diagnosis of pulmonary artery sarcoma is virtually never considered prior to surgery (pulmonary embolectomy) or autopsy, most of these tumours being diagnosed at post-mortem. It is presumably due to this and to the fact that such patients usually present with signs and symptoms of chronic pulmonary thromboembolism causing clinical confusion that contributes to their dismal prognosis. We have recently diagnosed two cases of pulmonary artery sarcoma prior to post-mortem and surgical confirmation. In both cases ventilation perfnsion scan demonstrated a unilateral perfusion defect with normal ventilation. M R showed a solid mass arising from the main pulmonary artery consistent with t u m o u r in both cases whilst C T scanning showed an intraluminal filling defect in the second case only. Subtotal resection of the t u m o u r was undertaken in the second case but unfortunately the patient died 10 days post-operatively. We will review the literature and both cases of pulmonary artery sarcoma and the contribution of M R imaging to the diagnosis.
TRANSIENT ISCHAEMIA ATTACKS DUE TO MENINGIOMAS E. W. C A M E R O N
Department of Radiology, Charing Cross Hospital, London Transient ischaemic attacks (TIAs) are defined as episodes of focal neurological dysfunction in a specific arterial vascular (carotid or