Modern mammography is the most effective means of detecting nonpalpable breast cancers, but correct diagnosis for malignancy is made in only 20%-30% of the cases. The conventional method of lesion localization usually results in approximate placement of the hookwire in the breast. The authors report the results of stereotaxic localization, combined with fine-needle aspiration and cytologic study, performed in 528 cases. Clinically occult breast lesions were localized precisely (within 2 mm 96% of the time), sampled by means of a 23-gauge needle, and marked with either methylene blue or a hookwire for subsequent open excisional biopsy. The results indicate a sensitivity of 95%, specificity of 91%, and accuracy of 92% for the fine-needle aspiration procedure. This technique offers a significantly improved preoperative method of diagnosing small breast lesions with minimal pain, no complications, reduced cost, and no disfigurement or scar interfering with subsequent mammographic follow-up.

A stereotaxic technique for localization of occult breast lesions and fine needle aspiration for cytological diagnosis was used on examination of 543 patients. Successful localization with the needle tip within 1 mm of the suspected lesion was possible in 490 patients (90.2%). Based on a high mammographic index of suspicion for malignancy, 187 of 490 patients were selected to undergo open biopsy, following aspiration cytology and localization with methylene blue injection. The statistical results (cytologic vs. histologic examination) revealed a sensitivity of 97.5% and a specificity of 95.2% for cytologic diagnosis of occult breast lesions. The technique is easy to learn and takes 20-30 minutes to perform. Compliance was 100% and complications were nil. This new technique expedites localization and maximizes the specificity of mammography for occult breast lesions.

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A total of 59 cases of nephroblastoma and related neoplasms were studied by flow cytometry of paraffin-embedded tissue. According to clinical prognosis, cases were subdivided into three groups: Group 1 (low risk) consisted of congenital mesoblastic nephroma (n = 13) and cystic, partially differentiated nephroblastoma (n = 2). Group 2 (intermediate risk) comprised the various subtypes of "typical" nephroblastoma (n = 24) including cases of fetal rhabdomyomatous nephroblastoma (n = 4). In group 3 (high risk) there were cases of anaplastic nephroblastoma (n = 3), clear cell sarcoma of the kidney or "bone metastasizing renal tumor of childhood" (n = 7), and malignant rhabdoid tumor of the kidney (n = 6). The three clinically different groups of tumors also varied in the proportion of cases with aneuploid tumor DNA stemlines, in S-phase fractions, and in proliferation indices (PI = S + G2 + M). Group 1 was generally characterized by a small number of cases with aneuploid tumor DNA stemlines and low values for S-phase fractions and PI, whereas Group 3 showed the largest number of cases with aneuploid tumor DNA stemlines and high values for S-phase fractions and PI. Group 2 was in between. It is concluded that flow cytometry on paraffin-embedded tissue from pediatric tumors may be a useful adjunct in determining prognosis, and that the subdivision of nephroblastomas and related neoplasms into three prognostically different groups is warranted.