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Background. Breast screening has decreased morbidity and mortality due to detection of early, non-palpable breast cancers. One of the challenges of performing breast-conserving surgery on non-palpable breast tumours is accurate localization of the cancer. We aimed to perform a feasibility study to examine the outcomes associated with the introduction of a novel radiofrequency identification system (RFID) called LOCalizer as an alternative to traditional wire-guided localization. Methods. Data were prospectively collected on all patients undergoing breast-conserving surgery using the LOCalizer RFID system in a regional cancer centre between July 2019 and March 2020. Patients had a RFID tag placed preoperatively and underwent surgical removal of the tag with the index lesion guided by a handheld LOCalizer probe. The primary aim was successful placement and retrieval of the RFID tag. Re-excision rates, specimen size, specimen weight, cancer subtype and complication rate were all recorded. Results. Sixty-nine patients aged between 50 and 69 years had a LOCalizer tag inserted between July 2019 and March 2020. Of these, 6 (8.7%) were diagnostic and 63 (91.3%) were therapeutic. There was no migration of RFID tags, and all tags were retrieved with the index lesion. The overall re-excision of margin rate was 17.4% (12/69). All re-excision of margins was due to positive radial margins. The overall complication rate was 1.4% with one grade 1 Clavien-Dindo morbidity. Conclusion. The LOCalizer RFID is an effective and safe wire-free localization method for non-palpable breast lesions.

Background The new imaging technology made available today allows for an early detection of small subclinical breast lesions which frequently call for guided presurgical micro-histology. Purpose To evaluate the relationship between vacuum-assisted breast biopsy (VABB) histopathological diagnoses and mammographic findings in non-palpable breast lesions. Material and Methods The breast lesions of 1393 women who had received consecutive screening mammograms between 2001 and 2007 were assessed by VABB. The mammographic breast lesions, classified according to the Breast Imaging Reporting and Data System (BI-RADS), were subjected to VABB only if rated as highly suspicious (2%), suspicious (64.5%) for malignancy, or probably benign (33.5%). Results VABB findings included 981 (70.5%) probably benign lesions, 407 (29.2%) suspicious/malignant lesions, and five (0.3%) cases which were considered as inappropriate for diagnostic purposes. At histology, 10.2% of the suspicious/malignant lesions were classified as proliferative lesions, 11.1% as ductal carcinoma in situ (DCIS), and 8% as invasive ductal carcinoma (IDC). The positive predictive value (PPV) of BI-RADS assessment categories 3, 4 and 5 was 4.1%, 25.3% and 75%, respectively. The occurrence of obscured or spiculated masses was found to exhibit the highest PPV for malignancy (12.5% in BI-RADS 3 and 63% in BI-RADS 4), followed by microcalcifications which showed a malignancy rate of 6.4% in BI-RADS 3, and 20% in BI-RADS 4. Conclusion VABB turns out to be effective in the assessment of many malignant and benign preclinical tumour lesions thus allowing for a significant reduction of the number of surgical biopsies.

The unexpected detection of non palpable hypoechoic testicular lesions has become more frequent thanks to the increased use of trans-scrotal ultrasound (US): patients are often asymptomatic and the objective examination reveals no palpable masses. The different diagnostic, therapeutic approaches vary from radical orchifunicolectomy to simple US follow-up, although the guidelines on the management of these lesions are not defined, yet. The article shows our series of patients with hypoechoic testicular lesions who underwent surgical exploration, with the aid of the operating microscope and histologic test. Materials and Methods 6 patients in total underwent microsurgical exploration of non palpable hypoechoic testicular lesions, from April 2003 to December 2004. Results 4 out of the 6 cases were a left-sided testicular lesion, whereas the 2 remaining cases revealed a right-sided lesion [hypoechoic areas mean size = 3.9 mm (range 2.5 – 16)]. The lesions in all patients could be easily identified and successfully excised thanks to the microsurgical technique. The intraoperative frozen section examination (FSE) showed a benign lesion in 5 cases and an intratubular germ cell neoplasia (ITGCN) in one. Patient with ITGCN underwent radical orchiectomy. The final histological analysis confirmed the frozen section examination report for all the 6 cases. Patients were clinically and ultrasonographically evaluated with a mean follow-up of 15 months. No complication occurred. Conclusion Microsurgical exploration of the testis combined with FSE represents a safe, effective and reliable technique in case of non palpable hypoechoic testicular lesions. This approach leads to significant advantages and should be considered especially in patients with a solitary testis or presenting bilateral lesions, and wishing to father a child.

Aims and background Diverse and contradictory approaches have been suggested for the management of non-palpable thyroid nodules. The aim of our study was to evaluate the indications and limits of ultrasound-guided fine-needle aspiration cytology (US-FNAC) in non-palpable infracentimetric thyroid nodules. Methods and study design From September 2003 to December 2004 we observed 325 patients with non-palpable thyroid nodules. We divided our series into three groups according to the diameter of the lesion in order to verify the effectiveness of US-FNAC for lesions of less than 1 cm. Results We assessed the cases with satisfactory and unsatisfactory results in the three groups into which the sample was divided (4 mm to 1 cm; 10.1 mm to 15 mm, and 15.1 mm to 25.5 mm). Our statistical analysis by means of the z-test showed there was no significant (5%) difference in the percentage distribution of the unsatisfactory results in the three groups. Conclusions Fine-needle cytology appears to be a useful diagnostic tool also for nodules of less than one cm because the percentage of unsatisfactory results is not related to the size of the nodule.

Laparoscopy plays an outstanding role in the diagnosis of non palpable testis. Laparoscopy is as accurate as surgical exploration but, compared with the latter, is less invasive and faster; moreover in cases of testicular absence it makes surgery unnecessary. Concerning laparoscopic surgery in the case of abdominal testis, orchiectomy is an easy procedure which prolongs diagnostic laparoscopy for only a short time. It is indicated in pediatric patients with hypoplasic testis. In adult patients, except for cases of monorchidism and bilateral abdominal testis, orchiectomy is always recommended. At present laparoscopic orchiopexy does not seem to offer sure advantages compared to traditional surgery.

The Authors report on their case histories of impalpable testes using laparoscopy for diagnosis. They also report their first experience of therapeutic laparoscopy in adults and children, as a natural development of adequate training.

A new method for preoperative marking has been evaluated in 56 non-palpable lesions of the breast. With the aid of a stereotaxic biopsy instrument the lesion is located and an aqueous suspension of carbon particles is injected so as to leave a distinct trail from the lesion out to the skin. This trail gives precise guidance to the site of the lesion, facilitating the removal of a minimum volume of tissue. According to current experience, the carbon does not diffuse into surrounding tissues and therefore the marking can be done well in advance of surgery.

Marking of non-palpable breast lesions for biopsy has become a routine procedure in patients in whom mammography has suggested malignancy. Between October 1981 and December 1985 a localization method was used in 123 patients. In 35 per cent of the biopsies a malignant lesion was disclosed. In patients with a mass only, malignancy was found in 37 per cent of the biopsies. If microcalcifications alone were the main reason for the biopsy, malignancy was disclosed in 25 per cent. If both a mass and microcalcifications were present, 52 per cent of the biopsies disclosed a malignant lesion.

Eighty-seven mammary biopsies with radiographic signs of malignancy (microcalcifications or tissue condensation) without a corresponding clinical mass were examined by specimen radiography to determine the mammary lesion microscopically and find the exact location of the possibly malignant-associated microcalcifications. Fourteen malignant lesions (16.1%) were found, and atypical intraductal proliferations in an additional 14 biopsies. The calcifications were mostly located in the atypical epithelium. In 9 cases, however, the calcifications were located at a distance from the atypical epithelium. An open guided biopsy Is therefore considered to be mandatory in these cases.

Results with a previously described device for fine needle biopsies of non-palpable breast lesions are reported. During the past 5 years 182 biopsies were performed and 133 of these yielded diagnostic cell material. In the series, 41 carcinomas were found and fine needle biopsy in all demonstrated malignant or probably malignant cells. In the biopsies evaluated as benign or probably benign, malignancy has not been found during the observation period of 4 to 59 months (mean 21.5 months). The device described is cheap and biopsy is easily performed and, if necessary, repeated in a short time. The diagnostic accuracy is high and carcinomas as small as 3 mm in diameter have been diagnosed.

Stereotaxic needle biopsy was performed on 121 radiographically demonstrated non-palpable breast lesions, which were excised within 3 months after the needling. Of the 62 histopathologically proven malignant tumors, malignant or probably malignant epithelial cells were obtained at needle biopsy, in about 80 per cent of cases, in which the cellular material was quantitatively adequate. There was no false positive cytologic result. The combined radiologic and cytologic assessment gave a correct diagnosis in 61 of the 62 histopathologically malignant tumors. There was metastatic tumor involvement of the lymph nodes in only 3 of the malignant tumors.