The aim of this study was to evaluate the use of [(18)F]fluorothymidine (FLT) as a positron emission tomography (PET) tracer for the diagnosis of breast cancer. To this end, 12 patients with 14 primary breast cancer lesions (T2-T4) were studied by FLT-PET. For comparison, [(18)F]fluorodeoxyglucose (FDG) PET scans were performed in six patients. Thirteen of the 14 primary tumours demonstrated focally increased FLT uptake (SUV(mean)=3.4+/-1.1). Seven out of eight patients with histologically proven axillary lymph node metastases showed focally increased FLT uptake in the corresponding areas (SUV(mean)=2.4+/-1.2). The lowest SUV (mean =0.7) was observed in one of two inflammatory cancers. The contrast between primary tumours or metastases and surrounding tissue was high in most cases. In direct comparison to FDG-PET, the SUVs of primary tumours (5/6) and axillary lymph node metastases (3/4) were lower in FLT-PET (SUV(FLT): 3.2 vs SUV(FDG): 4.7 in primary tumours and SUV(FLT): 2.9 vs SUV(FDG): 4.6 in lymph node metastases). Since FLT uptake in surrounding breast tissue was also lower, tumour contrast was comparable to that with FDG. It is of note that normal FLT uptake was very low in the mediastinum, resulting in a higher tumour-to-mediastinum ratio as compared to FDG ( P=0.03). FLT-PET is suitable for the diagnosis of primary breast cancer and locoregional metastases. High image contrast may facilitate the detection of small foci, especially in the mediastinum.

Clinical and histological data of 168 patients with squamous cell carcinoma of the vulva were analyzed with respect to survival. 151 patients underwent surgery, 12 patients were treated with primary radiation and in 5 patients no treatment was performed. Follow-up lasted from at least 2 up to 22 years’ posttreatment. In univariate analysis, the following factors were highly significant: presurgery lymph node status, tumor infiltration beyond the vulva, tumor grading, histological inguinal lymph node status, pre- and postsurgery tumor stage, depth of invasion and tumor diameter. In the multivariate analysis (Cox regression), the most powerful factors were shown to be histological inguinal lymph node status, tumor diameter and tumor grading. The multivariate logistic regression analysis worked out as main prognostic factors for metastases of inguinal lymph nodes: presurgery inguinal lymph node status, tumor size, depth of invasion and tumor grading. Based on these results, tumor biology seems to be the decisive factor concerning recurrence and survival. Therefore, we suggest a more conservative treatment of vulvar carcinoma. Patients with confined carcinoma to the vulva, with a tumor diameter up to 3 cm and without clinical suspected lymph nodes, should be treated by wide excision/partial vulvectomy with ipsilateral lymphadenectomy.

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In patients with benign lesions on imaging, open biopsies can be avoided by LCNB. In patients with biopsy proven carcinoma, therapy planning is improved. The addition of morphobiological parameters allows early individual treatment.

Zusammenfassung Fragestellung: Evaluation der 11-G HH Mammotome-VB von 58 Mammaläsionen unter Ultraschallsicht (US) hinsichtlich Durchführbarkeit, Komplikationen und Indikationsspektrum. Patientinnen und Methoden: Analyse von 54 Patientinnen mit 58 Mammaläsionen, die nach einem in unserer Brustklinik erarbeiteten Indikationskatalog von Juni 2000 bis Oktober 2001 mit dem Handheld Mammotome unter US-Sicht ambulant vakuumbiopsiert wurden. Eine Follow-up-Untersuchung wurde 1 Woche und 3 Monate nach Biopsie klinisch und sonographisch durchgeführt. Ergebnisse: 58 Läsionen wurden anhand folgender Indikationen vakuumbiopsiert: potenziell benigne Befunde wie störende Mastopathieknoten (n = 10), ¹weitestgehende Exstirpationª von Fibroadenomen (FA) £ 1,5 cm (n = 13), Exstirpation rezidivierend schmerzhafter und unklarer Zysten/Papillome (n = 3), narbige Fibrosen, Fettnekrosen, DD Rezidiv (n = 10), postoperative Hämatombildung (n = 4), Mammakarzinome (MaCa) (n = 18) und Clipmarkierung bei 5 Patientinnen. Bei 35% der benignen Läsionen gelang die sonographische Komplettentfernung. Die Komplikationen sind mit denen der 14-G-Hochgeschwindigkeits-Stanzbiopsie (HGS) vergleichbar. Das Verhältnis HGS : VB unter US-Sicht beträgt an unserer Klinik derzeit ca. 5 : 1. Schlussfolgerung: Die Handheld Mammotome-VB ist ein patientinnenfreundliches, komplikationsarmes Mikrobiopsie-Verfahren, welches die Gewinnung gröûerer Gewebevolumina erlaubt und die Rate unnötiger offener Mammabiopsien senken Abstract Objective: To evaluate the HH Mammotome 11-G vacuum biopsy (VB) of 58 breast lesions under ultrasound (US) guidance regarding feasibility, complications and indications. Patients and Methods: We analysed 58 breast lesions of 54 patients (pts), who were biopsied with the HH Mammotome under US guidance for certain indications from June 2000 until October 2001. A follow-up visit (clinic and US) was performed 1week and 3 months after biopsy. Results: 58 breast lesions were vacuum biopsied due to the following indications: potentially benign lesions like mastopathic nodes (n = 10), fibroadenoma < 1.5 cm (n = 13), extirpation of pain causing and unclear cysts and papilloma (n = 3), fibrosis, liponecrosis DD scar/recurrence (n = 10), postoperative hematoma (n = 4) and breast carcinoma (n = 18). Microclip placement in 4 lesions during biopsy. In 14 benign lesions sonographic complete extirpation was achieved (35% of benign lesions). Complications of the HH Mammotome biopsy are rare and comparable with those of core cut biopsy. The ratio core cut biopsy : VB at our clinic is approximately 5 : 1. Conclusion: The HH Mammotome VB is a patient-friendly safe microbiopsy procedure that allows improved tissue harvesting for pathology and that might help to decrease the rate of unnecessary open breast biopsies. The possibility of a central clip placement could precise the operative procedure after a given neoadjuvant therapy. Careful choice of indications as well as cost-effectiveness-analyses compared to the conventional core Originalarbeit 346 Institutsang...