Object. The authors evaluate the effects of implantation of a carbon fiber cage after anterior cervical discectomy (ACD) on the height of the foramen and the angulation between endplates of the disc space. Methods. Thirteen consecutive patients who were scheduled for standard microscopic ACD and interbody fusion underwent thin-slice (1.5 mm) spiral computerized tomography scanning 1 day preoperatively, 1 day postoperatively, and 1 year postoperatively. Oblique sagittal reconstructions were made through both foramina; the height of each foramen and the angle between the endplates were measured. Because 16 cages were implanted, 32 foramina were investigated. Preoperatively, the mean height of the foramina (± standard deviation) was 8.1 ± 1.5 mm (range 5.7–12 mm), and at 1 day postoperatively it was 9.7 ± 1.4 mm (range 7.5–12.8 mm). This difference reached statistical significance (p < 0.0005). The mean foraminal height after 1 year was 9.4 ± 1.4 mm (range 6.9–12.7 mm). In terms of the preoperative value, the 1-year measurement still reached statistical difference (p < 0.005) but not with the direct postoperative mean foraminal height. Preoperatively the mean value of the angle between the two adjacent endplates was 1.3 ± 2.4° (range 0–8°), and postoperatively it was 7.8 ± 2.9° (range 2–12°), which was statistically significant (p < 0.0005). Conclusions. The cervical carbon fiber cage effectively increased the height of the foramen even after 1 year, which contributed to decompression of the nerve root. The wedge shape of the device may contribute to restoration of lordosis.

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A recent case of the absent cervical pedicle syndrome is presented. Incorrect radiological interpretation resulted in inappropriate management. A review of the literature on this congenital abnormality and a complete differential diagnosis are presented.

Manuscript category Original Article Condensed AbstractThe modified core wash cytology procedure is a valuable tool for obtaining a rapid diagnosis from core needle biopsies of breast lesions. 2 AbstractAim: A quick and reliable preliminary diagnosis is essential in the management of a sameday breast clinic. In a preclinical study we developed an alternative method of core wash cytology (CWC). This study is an evaluation of this new CWC method introduced into the clinical setting.Methods: From April 2008 to April 2009, biopsies were taken from lesions in the breast.CWC was obtained from core needle biopsy (CNB) with a modified technique and classified into the categories: malignant, suspicious for malignancy, atypical, benign and inadequate.CWC and CNB diagnoses were correlated with the histopathology of subsequently obtained resection specimens. The sensitivity and specificity were calculated.Results: CWC was obtained from 226 breast lesions. In 167 of these cases subsequent resection of the lesion was performed revealing 149 carcinomas and 18 benign lesions.Of the 149 malignant cases, 136 were considered as either malignant or suspicious for malignancy by CWC, 7 as atypical, 4 as benign and 2 as inadequate. None of the 18 benign lesions were classified as suspicious or malignant on CWC. Eight out of 149 resected carcinomas were not recognized as malignant by histological analysis of the CNB, while 7 of these cases the CWC was considered malignant. The sensitivity and specificity were 97% and 100%, respectively. Conclusions:In the vast majority of patients the modified CWC technique can provide a quick and reliable diagnosis of malignant breast lesions. Furthermore, combining CWC with CNB histology can improve adequate, preoperative recognition of the malignant character of breast lesions.

Background.The histologic core needle biopsy (CNB) diagnosis is gaining importance in the initial diagnostic workup of breast lesions. However, CNB diagnosis requires 24 hours of processing while cytology can allow diagnosis within 1 hour. A quick reliable preliminary diagnosis is essential in the management of the one-day breast clinic.After a successful preclinical study investigating the diagnostic potential of an alternative method of core wash cytology, this method has now been introduced into the clinical setting.1 We hereby present the first data.Materials and methods.From April 2008 to April 2009, ultrasound guided biopsies were obtained from all palpable and non-palpable lesions in the female breast in our institute. Core wash cytology was derived from the CNB with the modified technique and classified in the categories proposed by the 1996 National Cancer Institute-sponsored conference approach: malignant, suspicious for malignancy, atypical, benign and unsatisfactory. The results of the core washes and the CNBs were correlated with the histopathology of subsequently obtained resection specimens. Suspicious for malignancy and malignant was considered as positive. Sensitivity and specificity were calculated.Results.Core wash cytology was obtained from 226 breast lesions. The age of the patients ranged from 21-92 years (median 57,5 years). In 167 of these cases subsequent resection of the lesion was performed in the follow-up. The specimens revealed 149 carcinomas (ductal 111, lobular 24, mucinous 4, tubular1, medullary 1, papillary 1 and 7 intraductal carcinoma grade 2/3). Of the 149 malignant cases 136 were classified as either malignant or suspicious for malignancy on core wash cytology, 7 cases were classified as atypical, 4 as benign and 2 as unsatisfactory. The remaining 18 resected cases were benign (adenosis 4, benign fibrous tumors 9, intracystic papilloma 1, mastitis 1, fat necrosis 2 and 1 mammary duct ectasia). None of the benign lesions were classified as suspicious or malignant on core wash cytology. Eleven lesions were classified as benign, 3 as atypical and 4 as unsatisfactory on core wash cytology. The sensitivity and specificity of the core wash compared to the definite resection diagnosis were 90% and 100%, respectively (95% confidence interval: 86%-95%).Comparing the core wash diagnoses to those on CNBs in the group of 149 resected carcinomas, it was noted that in 8 cases, which were negative on CNB, 5 cases revealed positivity on core wash cytology.Conclusion.The introduced modified technique on core wash cytology can provide a reliable preliminary indication of the likely CNB diagnosis. The modified core wash cytology is a sensitive and quick method for the detection of malignant breast lesions. This information is valuable for same-day patient counselling and management planning.Furthermore, combining core wash cytology with CNB findings can lead to an increase in the number of positive preoperative diagnoses in malignant lesions of the breast.So, don't be reluctant or afraid to implement cytology in the diagnostic work-up of breast lesions.Accepted for publication February 2009 in Cancer Cytopathology Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6017.