Purpose
The second International Consensus Conference on B3 lesions was held in Zurich, Switzerland, in March 2018, organized by the International Breast Ultrasound School to re-evaluate the consensus recommendations.
Methods
This study (1) evaluated how management recommendations of the first Zurich Consensus Conference of 2016 on B3 lesions had influenced daily practice and (2) reviewed current literature towards recommendations to biopsy.
Results
In 2018, the consensus recommendations for management of B3 lesions remained almost unchanged: For flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL) and radial scars (RS) diagnosed on core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB), excision by VAB in preference to open surgery, and for atypical ductal hyperplasia (ADH) and phyllodes tumors (PT) diagnosed at VAB or CNB, first-line open surgical excision (OE) with follow-up surveillance imaging for 5 years. Analyzing the Database of the Swiss Minimally Invasive Breast Biopsies (MIBB) with more than 30,000 procedures recorded, there was a significant increase in recommending more frequent surveillance of LN [65% in 2018 vs. 51% in 2016 (
p
= 0.004)], FEA (72% in 2018 vs. 62% in 2016 (
p
= 0.005)), and PL [(76% in 2018 vs. 70% in 2016 (
p
= 0.04)] diagnosed on VAB. A trend to more frequent surveillance was also noted also for RS [77% in 2018 vs. 67% in 2016 (
p
= 0.07)].
Conclusions
Minimally invasive management of B3 lesions (except ADH and PT) with VAB continues to be appropriate as an alternative to first-line OE in most cases, but with more frequent surveillance, especially for LN.
MRI is recommended as the method of choice in the preoperative evaluation of SCC of the oral cavity and the oropharynx. PET can provide relevant diagnostic information in case of equivocal findings by MRI or CT. Routine use of PET, however, does not appear to be necessary if optimized MRI is available.
The purpose of this study was to evaluate the use of combined transmission and emission tomography (TET) for correct localisation of heterotopic splenic tissue and differentiation of splenosis from other masses. The TET technique comprises the fusion of SPET and CT data obtained using the same imaging device to allow perfect overlap of anatomical and functional images. TET was performed in seven patients who either had haematological disorders and relapsing anaemia or thrombocytopenia after splenectomy or were under immunosuppression for different reasons. These patients presented 20 equivocal lesions on CT or MRI. Presence of splenic tissue was investigated using technetium-99m labelled colloids or heat-damaged red blood cells. Findings of spleen scintigraphy, TET and CT or MRI were compared with respect to localisation of splenosis and correct classification of lesions by CT or MRI. Histological validation was achieved by surgery or biopsy in all cases. All 20 lesions demonstrated by CT or MRI were correctly classified by TET as splenosis. Three additional lesions initially overlooked by CT or MRI could be detected. Diagnostic relevance was highest for intrahepatic, intrapulmonary or pleural splenic implants. It is concluded that TET allows exact localisation of heterotopic splenic tissue in patients with suspected splenosis.
Inflammatory, traumatic, and neoplastic diseases of the head and neck are best evaluated with cross-sectional imaging (CT, MRI) in accordance with current guidelines. Conventional x-rays should, in general, only be used for dental evaluation, with rare exceptions.
Orbitozygomatic fractures pertain to the most common injuries in craniofacial trauma patients. Accurate fracture reduction is of high importance for a successful outcome. This pilot study was performed to assess the potential benefit of surgical navigation to aid in orbitozygomatic fracture reduction. A non-comparative series of five consecutive patients with severely displaced orbitozygomatic fractures was treated using the guidance of computed tomography (CT)-based surgical navigation. Using a previously developed software platform, the fracture was reduced virtually by a three-dimensional shifting of the orbitozygomatic complex within the patient's preoperative multimodal CT data set. This treatment plan was transferred to a navigation system. Fracture reduction was performed according to the treatment plan using surgical navigation. Intraoperative control of fracture reduction by comparing the real with the virtual bone position using surgical navigation showed up as a helpful tool. Accurate treatment planning and immediate evaluation of craniofacial surgery outcome are the benefits of the new approach demonstrated. A major drawback of the presented approach is a high consumption of human and financial resources. A larger clinical series with long-term follow-up will be needed to determine reproducibility and cost-effectiveness. In addition to bone repositioning, a future application may include simulation of craniofacial osteotomies.
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