Department of Radiology

Hadassah University Hospital

Ein-Karem, Jerusalem

Tel: work: 972-2-6777111

Home: 972-2-5330159

FAX: work: 972-2-6437531

E-mail: mirisl@hadassah.org.il

Birth Date: April 7,1962 

Birthplace : Russia

Citizenship: Israeli

Marital status: Married + 2

Home address: Hermon 48/9 Mevaseret Jerusalem

Education: 1974-1978 - High school, Tel-Aviv, Israel

Army Service: - 1978-1980 Military service, rank upon discharge: Lieutenant

Higher Education and Academic degrees

1980-1982 - Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel

1982-1990 - Hadassah Medical School, The Hebrew University, Jerusalem, Israel, Graduated M.D.

1991-1992 - Rotating internship, Hadassah University Hospital, Jerusalem, Israel

1992 - Received M.D. degree, The Hebrew University, Jerusalem, Israel

1992-1996 - Residency in Diagnostic Radiology, Department of Radiology (Head: Prof. J. Bar-Ziv), Hadassah University Hospital, Jerusalem, Israel

1995-1996 - Chief resident, Department of Radiology, Hadassah University Hospital, Jerusalem, Israel

1996 - Certification by Israel Board of Diagnostic Radiology

1996-1999 - Attending physician in the Radiology department of Hadassah University Hospital, Jerusalem, Israel

1998 - ECFMG certification, and English Test.

1999-2000 - Body Imaging Fellowship - University of Toronto.

2000-2001 - Breast Imaging Fellowship - University of Toronto.

2001- Present - Senior physician. Radiology department Hadassah University Hospital, Jerusalem

1995-2001 - Academic appointment – Tutor

Oct. 2001 – Academic appointment - Lecturer

Grants and Awards

1991 - The Salivan-Lavi memorial award in recognition of excellence for Doctoral Thesis on completion of graduate medical degree: “Hypouricemic effect of Chlorprotixene: a potential marker of drug compliance”.

2003 - Special award from Hadassah Hospital for a research day

2004 - Continuation of Special award from Hadassah Hospital for a research day

2003 - 5000$ Grant Israel Cancer Association; Clinical , Radiological and pathological characteristics of breast cancer in women who underwent treatments for infertility .

2004 - 5000$ Department Grant ; Mammographic Breast Density in Ethiopian Women in Israel – Is It Indeed less dense?

List of Publications

Original Research Papers

Sklair-Levy M, Bloom AI, Sherman Y, Fields S, Bar-Ziv J,Libson E. CT guided core needle biopsy of abdominal, pelvic and retroperitoneal masses. Harefuah 1997; 132: 318-323. (in Hebrew) (x;x;0)

Sklair-Levy M, Shaham D, Sherman Y, Bar-Ziv J, Libson E. Fine needle aspiration biopsy of mediastinal masses guided by Computed Tomography-   summary of our experience in 63 patients. Harefua 1998;134:599-602.(in Hebrew) (x;x;1;0)

Hirshberg B, Sklair-Levy M, Nir-Paz R, Ben-Sira L, Krivoruk V, Kramer M. Factors predicting mortality of patients with Lung Abscess. Chest 1999 ;115:746-50. (3.264;11/70;7/31;7;7)

Hirshberg B, Oppenheim-Eden A, Pizov R, Sklair-Levy M, Rivkin A, Bardach E, Bublil M, Sprung C, Kramer M. Recovery from blast lung injury: One year follow–up. Chest 1999;116:1683-88. (3.264;11/70;7/31;1;1)

Sklair-Levy M, Polliack A, Shaham D, Applbaum YH, Gillis S, Ben-Yehuda D, Sherman Y, Libson E. CT-guided core-needle biopsy in the diagnosis of mediastinal lymphoma. Eur Radiol 2000;10:714-8. (1.969;29/83;6;6)

Sklair-Levy M, Agid R, Sella T, Straus-Liviatan N, Bar-Ziv J. Age related changes in CT attenuation of the in children. Pediatr Radiol 2000;30:566-569 (0.942;39/68;59/83;0)

Sklair-Levy M, Samuels T, Catzavelos C, Hamilton P, Shumac R. Stromal Fibrosis: false-negative rate at percutaneous core biopsy. AJR 2001;177(3):573-579  (2.474;18/83;0)

Sklair-Levy M, Lebensart P, Applbaum YH, Ramu N, Freeman A,  Gozal D, Gross E, Sherman Y, Bar-Ziv J, Libson E. Needle biopsy in children- Summary of our experience with 57 children. Pediatr Radiol 2001;31(10):732-736 (0.942;39/68;59/83;4;4)

R.Agid, M.Sklair-Levy, A.I.Bloom, S.Lieberman, A.Polliack, D.Ben-Yehuda, Y.Sherman, E.Libson. CT-guided biopsy with cutting-edge needle for the diagnosis of malignant lymphoma: Experience of 267 biopsies. Clin Radiol 2003;58: 143-147. (1.270;45/83;2;2)

T.M.Allweis, A.Nissan,R.M.Spira, M.Sklair-Levy, H.R.Freund, T.Peretz. Screening mammography for early diagnosis of breast cancer: facts, controversies, and the implementation in Israel. Harefua 2003;142(4):281-286 (x;x;1;1)

Allweis TM,Parson B,Klein M, Sklair-Levy M, Rivkind A, Uziely B: Breast cancer draining to bilateral axillary sentinel lymph nodes.  Surgery. 2003 Sep;134(3):506-8. (2.611;14/141;4;4)

Stewart EA, Gedroyc WM, Tempany CM, Quade BJ, Inbar Y, Eherenstein T, Shushan A,

Hindley JT, Goldin RD, David M, Sklair-Levy M, Rabinovici J . Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gynecol. 2003 Jul;189(1):48-54 (2.518;7/53;11;10)

Buchbinder SS,  Leichter IS,  Lederman RB,  Novak B,  Bamberger FN,  Sklair-Levy M,  Yarmish G, Fields SI.  Computer-aided Classification of BI-RADS Category 3 Breast Lesions. Radiology 2004;230:820-823. (4.815;4/83;0)

Hindley J, Gedroyc WM, Regan L, Stewart E, Tempany C,  Hynnen K, Macdanold N, Inbar Y, Itzchak Y, Rabinovici J,  Kim K,  Geschwind J, Hesley G, Gostout B, Ehrenstein T, Hengst S, Sklair-Levy M, Shushan A, Jolesz F.   MRI Guidance of Focused Ultrasound Therapy of Uterine Fibroids: Early Results AJR 2004; 183:1713-1719 (2.474;18/83;0)

M.Sklair-Levy, G.Amir, G.Spectre, P.D.Lebensart, Y.H.Applbaum, R.Agid, S.Lieberman, D.Ben-Yehuda, Y.Sherman, E.Libson. Image guided cutting-edge-needle biopsy of perioheral lymph nodes and superficial masses for the diagnosis of lymphoma. (accepted for publication JCAT).

Clinical Observations (Case Reports)

Sklair-Levy M, Nassar H, Bar-Ziv J, Putterman C. Dissecting aortic aneurysm in systemic lupus erythematosus. Lupus 1995;4:71-74. (1.808;12/21;11;11)

Sklair-Levy M, Libson E, Lossos IL, Bugomolsky-Yahalom V. Case Report: Splenic calcifications caused by Trichosporon Beigelli infection. Eur Radiol 1998;8:922-24. (1.969;29/83;1;1)

Wollstein R, Wolf Y, Sklair-Levy M, Matan Y, London E, Nyska.M Obliteration of a late traumatic posterior tibial artery pseudoaneurysm by duplex compression. J Trauma 2000 Jun;48(6):1156-8. (1.429;8/16;48/141;1;1)

Shaham D, Sklair-Levy M, Weinberger G, Gomori JM. Lemierre’s syndrome presenting as multiple abscesses. (In press: Clinical Radiology). (1.270;45/83)

Letters

Sklair-Levy M, Simanovsky N, Shapira R. Primary Aorto-Duodenal fistula-Evaluation with computed tomography. Letter to the editor. Eur Radio 1999;9:1005. (0.897;49/78;0)

Chapter in book

Schenkar JC, Elchalal Y, Sklair-Levy M, Bar-Ziv J . Women’s Medicine. Chapter 36 (Pp:343-354); Computed Tomography of the female pelvis. 1st Ed, Diunon Publishers, Tel-Aviv University 1999. (In Hebrew)

Submitted for Publication

Primary breast Tuberculosis diagnosed by Ultrasound guided core needle biopsy (Breast )

Dual contrast MR imaging of the liver with Gadolinium and Ferucarbotran (Superparamagnetic iron oxide) (AJR).

Effect of Breast Magnetic Resonance Imaging on the Clinical Management of Breast Cancer (IMAG)

Current Research

Peiranal fistula. A comparison of endorectal US and MRI in the imaging  and diagnosis of perianal fistula.

The change in Perfusion of uterine fibroids following treatment with MR guided FUS.

Treatment of HCC with photodynamic therapy.

The role of breast MRI in screening high risk patients for breast carcinoma , BRCA1 and BRCA2 gene carriers.

The role of breast MR imaging in the pre-operative assessment of patients diagnosed with breast cancer.

Complex fibroadenoma – Is there a higher risk to develop breast carcinoma?

Clinical and pathological characteristics of breast cancer in women who underwent treatments for infertility. 

Abstracts

Sklair-Levy M, Libson E, Sherman Y, Gillis S, Polliak A. The value of CT guided core needle biopsy on diagnosis of mediastinal lymphoma.European Congress of Radiology (ECR) March 1999, Vienna, Austria.

Appelbaum YH, Sklair-Levy M, Pizer A, Sucher A, Bar-Ziv J,  Libson E. Needle biopsy guided by CT of the skeleton in children. 28th Congress of the Israel Radiological society. November 1998,Tel-Aviv.

Shaham D, Sosna J, Sklair-Levy M, Bogat N, Megido D, Bar-Ziv J,  Cohen R. Radiology teaching by computer compared to frontal lectures.28th Congress of the Israel society, November 1998,Tel-Aviv.

Applbaum YH, Sklair-Levy M, Peyser A, Sucher E, Bar-Ziv J, Libson E CT guided biopsies of the musculoskeletal system in children-accuracy and utility. 36th Congress of the European society of Pediatric Radiology, May 1999, Jerusalem, Israel.

Sklair-Levy M, Lebensart P, Applbaum YH, Ramu N, Freeman A, Gross E, Libson E Needle aspiration biopsy in children. 36th Congress of the European society of Pediatric Radiology, May 1999, Jerusalem, Israel.

Sklair-Levy M, Agid R, Sella T, Bar-Ziv J. Age related changes in attenuation of the thymus on CT in children. 36th Congress of the European society of Pediatric Radiology. May, 1999, Jerusalem, Israel

Sklair-Levy M, Samuels T, Catzavelos C , Hamilton P, Shumac R. Stromal Fibrosis. CAR , June 10-14 , 2000, Toronto, Canada

Sklair-Levy M, Muradali D, Kulkarni S. Linear transducer harmonic imaging: Improved characterization of breast cysts compared to conventional sonography. American Institute of Ultrasound in Medicine, 45th Annual Convention, March 11-14, 2001, Orlando, Florida.

Sklair-Levy M, Gomori JM, Revel A, Shoshan A, Yagel S. Treatment of uterine fibroids using MR imaging guided focused ultrasound. Radiological Society of North America (RSNA) 88th Scientific Assembly and Annual Meeting , December 1-6, 2002, Chicago.

Leichter IS, Lederman R, Buchbinder SS, Novak B, Sklair-Levy M, Fields S. Increased diagnostic performance with CAD assisted classification of mammographic lesions. Radiological Society of North America (RSNA) 88th Scientific Assembly and Annual Meeting, December 1-6, 2002, Chicago.

Sklair-Levy M,Gomori M, Libson E. MR Imaging of the liver with new superparamagnetic iron oxid-first experience. Israel Radiological Association , The Annual Meeting, 29-31, 2003, October,Eilat.

Sklair-Levy M,Sella T,Peretz T,Mally B,Libson E. The importance of second look ultrasound following suspicious breast MRI. Israel Radiological Association , The Annual Meeting, 29-31, 2003, October,Eilat.

Kisselgoff D,Galinsky D, Peretz T,Sklair-Levy M. Effect of Magnetic Resonance Imaging on the Clinical Management of Women Undergoing Screening for or during Treatment of Breast Cancer . Israel Radiological Association , The Annual Meeting, 29-31,2003, October,Eilat.

Sklair-Levy M,Gomori M,Shoshan A,Revel A,Yagel S. Treatment of Uterine Fibroids Using MR Imaging guided focused ultrasound. Israel Radiological Association , The Annual Meeting, 29-31,2003, October,Eilat.

Sklair-Levy M,Gomori M,Shoshan A,Revel A,Yagel S. Treatment of Uterine Fibroids Using MR Imaging guided focused ultrasound Radiological Society of North America (RSNA) 89th Scientific Assembly and Annual Meeting , November 30- December 5, 2003, Chicago

Leichter IS, Lederman R, Buchbinder SS, Novak B, Sklair-Levy M, Bamberger P. The use of an advanced two-tiered system in maximizing CAD performance for mammography. Radiological Society of North America (RSNA) 89th Scientific Assembly and Annual Meeting, November 30- December 5, 2003, Chicago

Fields S. Leichter I, Lederman R. Buchbindr S, Novak B, Sklair-levy M. Sperber F, Bamberger P. Improved mammographic accuracy by the use of an advanced two-tiered cad/cac system. The annual meeting of the Israel radiological association, 27-29 October 2004,Eilat.

Zahavi A, Ad-El D, Sklair-levy M., Capsular contracture in the breast – clinical and radiological assessment. The annual meeting of the Israel radiological association, 27-29 October 2004, Eilat.

Presentations

Sklair-Levy M, Libson E, Bloom R, Polliack A. Reappraisal of the Value of lymphangiography in the staging of Hodgkin's lymphoma.  23rd Congress of the Israel Radiological Society. May 1993 Jerusalem, Israel.

Sklair-Levy M, Shaham D, Sherman Y, Bar-Ziv J, Libson E. Fine Needle aspiration biopsy of mediastinal masses guided by CT  Summary of our experience in 63 patients. 27th Congress of the Israel Radiological Society. December 1997, Tel-Aviv, Israel.

Sklair-Levy M, Lebensart P, Apelbaum YH, Libson E. Core needle Biopsy guided by CT and US in children – summary of our Experience. 28th Congress of the Israel Radiological Society.  November 1998, Tel-Aviv, Israel.

Sklair-Levy M, Applabaum YH, Sherman Y, Gillis S, Polliack A, Libson E. the value of CT guided core needle biopsy on diagnosis of Mediastinal lymphoma. European Congress of Radiology, March 1999, Vienna, Austria

Sklair-Levy M, Samuels T, Catzavelos C, Hamilton P, Shumac R, S.  Stromal Fibrosis. CAR, June 2000, Toronto, Canada.

Sklair-Levy M, Gomori JM, Revel A, Shoshan A, Yagel S. Treatment  of   uterine fibroids using MR imaging guided focused    ultrasound. Radiological Society of North America (RSNA) 88th Scientific Assembly and Annual Meeting , December 1-6, 2002, Chicago.

Sklair-Levy M,Gomori M, Libson E. MR Imaging of the liver with new superparamagnetic iron oxid-first experience. Israel Radiological Association , The Annual Meeting, 29-31, October,2003, Eilat.

Sklair-Levy M,Sella T,Peretz T,Mally B,Libson E. The importance of second look ultrasound following suspicious breast MRI. Israel Radiological Association , The Annual Meeting, 29-31, October,2003, Eilat.

Sklair-Levy M,Gomori M,Shoshan A,Revel A,Yagel S. Treatment of Uterine Fibroids Using MR Imaging guided focused ultrasound. Israel Radiological Association , The Annual Meeting, 29-31, October,2003, Eilat.

Sklair-Levy M,Gomori M,Shoshan A,Revel A,Yagel S. Treatment of Uterine Fibroids Using MR Imaging guided focused ultrasound Radiological Society of North America (RSNA) 89th Scientific Assembly and Annual Meeting , Novemeber 30- December 5, 2003, Chicago.

Posters:

Image Guided Core-Needle Biopsy of Peripheral Lymph  Nodes and Superficial  Masses in the Diagnosis of  Lymphoma. M.Sklair-Levy, A.Polliack,  Y.H.Applbaum, R.Agid , S.Lieberman, D.Ben-Yehuda , Y.Sherman, G.Amir , E.Libson

Diagnostic dilemmas and clinical quandaries in the aftermath of terrorist attacks. O.Benjaminov, M.Sklair-Levy, M.Stein, A.Rivkind, M.Cohen. Radiological Society of North America (RSNA) 88th Scientific Assembly and Annual Meeting , December 1-6, 2002, Chicago.

Ultrasound features of the post lumpectomy site. M.Sklair-Levy, T.Sella, T.Alweiss, A.Rivkind, Y.Manny, E.Libson. Radiological Society of North America (RSNA) 89th Scientific Assembly and Annual Meeting , Novemeber 30- December 5, 2003, Chicago

Clinical and pathological characteristics of breast cancer in women who underwent treatments for infertility. T.Allweiss, M.Sklair-Levy, B.Mally, A.Revel, H.Freund, T.Peretz. 27th San Antonio Breast Cancer Symposium, December 8-11, 2004.

Scientific Review

At present there are two research projects:

1. The Role of Breast MRI in Local Staging and Early Detection of Contralateral Breast Carcinoma

Background and significance

The mammogram remains the only test that has been proven to reduce mortality of breast cancer. Nevertheless, mammography is limited in breasts that are difficult to image, such as dense breasts, augmented breasts, and breasts that have undergone breast conservation and radiation. The false-negative rate of mammography ranging from 5% to 15% has prompted investigation into other modalities for breast cancer detection. Of all the techniques that have been investigated, magnetic resonance imaging (MRI) has the highest sensitivity and can provide valuable information that is not appreciated on the mammogram.

Breast MRI performed for cancer detection requires the use of an intravenous contrast agent, such as gadolinium-diethylenetriamone pentaacetic acid (Gd-DTPA), which is taken up by areas of the breast where there is increased vascularity. Malignant lesions exhibit an increased number of blood vessels and increased vascular permeability due to leaky endothelial cells. When contrast is injected, malignant lesions will generally enhance rapidly and strongly. In general, breast cancers enhance more rapidly and washout faster than benign lesions.

Clinical indications for breast MRI include preoperative staging where MRI has been shown to detect occult multifocal (separate sites of tumor in the same quadrant) and multicentric (separate sites of tumor in different quadrants) disease that was not seen clinically or with conventional imaging methods. (1-4). Knowledge of multifocality and multicentricity is important to guide treatment decisions, as multicentricity will result in mastectomy whereas multifocal tumor has the potential to be conserved. The detection of additional sites of unsuspected tumor preoperatively could possibly improve the recurrence statistics for patients who are treated with breast conservation. This approach might change treatment from conservative surgery (lumpectomy) to mastectomy.

Studies have also shown that MRI is able to detect unsuspected carcinoma in the contralateral breast in approximately 3% of the patients undergoing preoperative evaluation [3].

Aim of the proposed study

The purpose of this study is to prove that breast MRI may detect occult carcinoma in the contralateral and ipsilateral breast- i.e. multifocal and multicentric disease. Our hypothesis is that preoperative MRI [staging] will improve the early detection of occult breast carcinoma and thus change the therapeutic approach and eventually improve the cure rate.

The hypothesis is that MRI will detect additional foci of disease that would have been missed otherwise. 

Research plan

We plan to examine 50 patients preoperatively, with a proven breast cancer over a period of two years. The study population will consist of women who were recently diagnosed with breast cancer following histologic biopsy and prior to surgery. Participation in the study will be offered to those women, following signing on an informed consent.

Study protocol

The protocol will include clinical evaluation, mammography, breast ultrasound and bilateral breast MRI, all performed prior to definitive surgery. All lesions detected by any of the above imaging modalities will be further investigated by biopsy. This will be the gold standard diagnosis. The performance of breast MRI will be compared to clinical examination, mammography and breast ultrasound.

The results of the study will be analyzed for sensitivity, specificity and positive and negative predictive values for cancer detection.

References

Harms SE, Flaming DP, Hesley KL, et al: MR imaging of the breast with rotating delivery of excitation off resonance: Clinical experience with pathologic correlation. Radiology 187:493-501,9,1993

Orel SG, Schnall MD, Powell CM, et al: Staging of suspected breast cancer: Effect of MR imaging and MR-guided biopsy. Radiology 196:115-122.21,1995

Fischer U, Kopka L, Grabbe E: Breast carcinoma: Effect of preoperative contrast-enhanced Mrimaging on the therapeutic approach. Radiology 213:881-888,1999

Esserman L, Hylton N, Yassa L, et al; Utility of magnetic resonance imaging in the management of breast cancer: Evidence for improved preoperative staging. J Clin Oncol 17:110-119, 1999

2. Early detection of Breast Cancer in Women at High Risk for Breast Carcinoma; Comparison between Mammography, and Breast Ultrasound

Background and Significance

Women who carry a constitutional mutation of the BRCA1 gene or the BRCA2 gene face a high lifetime risk of breast cancer. The cancer risk is significant in these women at age 25, and by the age of 70, approximately 80% of mutation carriers will have developed invasive breast cancer. [1]. After breast cancer is diagnosed in one breast, there is a 30% risk of developing cancer in the contralateral breast within 5 years. [2]. Although there is evidence that breast cancer risk can be reduced by prophylactic mastectomy [3], oophorectomy [4], and tamoxifen, [5] few women choose these interventions, and no preventive measure will eliminate the risk of breast cancer completely.

Current recommendations for the management of high-risk women include semi-annual clinical breast examination and annual mammography beginning between the ages 25 and 35 [6]. At present, mammography is the primary imaging modality used to detect early clinically occult breast cancer. Despite widespread endorsement of mammographic screening for high-risk women, no evidence to date has shown that routine mammography reduces cancer mortality in BRCA1 or BRCA2 carriers. Most hereditary breast cancers occur in premenopausal women, and the value of screening mammography is significantly lower for women below age 50 [7-9].

It may be that a combination of imaging modalities will be superior to any single screening technique. In the general population, ultrasound is not in use as a breast cancer-screening tool but is commonly used to evaluate breast abnormalities found at mammography or on physical examination. However, among high-risk women, ultrasound in combination with other methods may have a role in breast cancer screening. The purpose of our study is to determine whether ultrasound increases the ability to detect small breast cancers in high –risk women, beyond that of mammography and clinical breast examination.

Aim of the proposed study

The purpose of this study is to prove that breast ultrasound in conjunction with mammography and physical examination is superior to physical examination and mammography in the early detection and surveillance of high-risk patients for breast carcinoma. Our hypothesis is that screening of those patients using ultrasound in conjunction with physical examination and mammography, will improve the early detection of breast carcinoma, and thus potentially will increase its cure rate.

Research plan

We plan to examine a total of 261 patients BRCA1 and BRCA2 carriers over a period of two years. The study population will consist of women who are at the age of 25 to 60. The clinicians/oncologists, surgeons or OB/GYN specialists. Participation in the study will be offered to eligible women (and to their first-degree relatives) in the context of genetic counseling. These women will be invited to contact the study coordinator directly if they will whish to participate.

Study protocol

A standardized questionnaire will be filled out for each participating patient. The protocol will include evaluation by the following three modalities: clinical breast examination - semiannual, mammography- annual, bilateral screening breast ultrasound - semiannual, all performed at the Hadassah University Hospital, on the same day or within a week. For premenopausal women, screening will be performed during the second week of the menstrual cycle. In cases of clinical findings in the interval period, additional breast ultrasound will be performed for further evaluation. For women with a past history of breast cancer who had undergone breast-conserving surgery with or without radiation, bilateral breast screening will be performed, and for those who had undergone unilateral mastectomy, contralateral breast screening will be performed. . Any lesion, unless obviously benign by criteria established by Stavros [11] or the BIRADS, will be further evaluated by biopsy. The biopsy will be the gold standard diagnosis.

The results of the study will be analyzed for sensitivity, specificity and positive and negative predictive values for cancer detection.

Physical examination

Physicians experienced in breast examination will perform physical examination of the breast and regional lymphatic areas. Each examination will be coded as normal, suggestive of benign disease, or suspicious for malignancy.

Mammography

Conventional four-view film/screen mammogram will be performed and will be reviewed by a senior radiologist. Further views will be performed where necessary. Mammograms will be scored on a five-point scale, using the following American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) categories: 1., negative; 2, benign findings; 3, probably benign findings, short follow-up interval suggested; 4, suspicious abnormality, biopsy should be considered; and 5, highly suggestive of malignancy [10].

Ultrasound

An experienced physician blinded to the mammography results using a 7.5-MHz transducer will perform high-resolution ultrasound. The reports will be coded in a pattern similar to the BI-RADS categories. Any solid lesion, unless obviously benign by criteria established by Stavros [11], will be further evaluated by biopsy.

A biopsy will be recommended if a clinical breast examination, the mammogram or the screening ultrasound will be suspicious for cancer  (BI-RADS categories 4 or 5).

References

Ford D, Easton DF, Stratton M, et al: Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. Am J Hum Genet 62:676-689,1998

Robson M, Gilewki T, Haas B, et al: BRCA-associated breast cancer in young women. J Clin Oncol 16:1642-1649, 1998

Hartman LC, Schaid DJ, Woods JE, et al: Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 340:77-84, 1999

Rebbeck TR, Levin AM, Eisen A, et al; Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers. J Natl Cancer Inst 91:1475-1479, 1999

Fisher B, Constantino JP, Wickerham DL, et al: Tamoxifen for prevention of breast cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 90: 1371-1388, 1998

Burke W, Daly M, Garber J, et al: Recommendations for follow-up care of individuals with an inherited predisposition to cancer BRCA1 and BRCA2. JAMA 277: 997-1003, 1997

Smart CR, Hendrick RE, Rutledge JH, et al: Benefit of mammography screening in women ages 40 to 49 years. Cancer 75: 1619-1626, 1995

Tabar L, Duffy S, Vitak B, et al: The natural history of breast carcinoma: What have we learned from screening? Cancer 86: 449-462, 1999

Miller AB, Baines CJ, To T, et al: Canadian National Breast Screening Study: 1.Breast cancer detection and death rates among women aged 40-49 years. CMAJ 147:1459-1476, 1992

American College of Radiology (ACR) reporting system, in Breast Imaging Reporting and Data System (BI-RADS) (Ed 2). Reston, VA, American College of Radiology, 1993, PP 15-18

Stavros AT, Thickman D, Rapp CL, et al: Solid breast nodules: Use of sonography to distinguish between benign and malignant lesions. Radiology 196: 123-134, 1995

In the past I have described our experience with percutaneous core needle biopsies, in general and especially in the diagnosis of lymphoma. (1,2,5)

In recent years the approach to the routine diagnosis of lymphoma has changed. The development of image guided biopsy techniques using CT or US has facilitated the development of nonsurgical sampling of tumor masses in both the abdomen and the retroperitoneum. At the same time, the ability to classify lymphoma in small samples has also improved primarily because of the progress in histopathologic diagnostic techniques, particularly immunophenotyping and immunohistochemistry.

The purpose of our study was to determine the role of image-guided percutaneous core needle biopsy in the diagnosis and subsequent management of patients with mediastinal lymphoma. In the past patients with a mediastinal mass suspicious for lymphoma were subjected to several diagnostic procedures including open biopsy and surgery. However, with the availability of CT guidance, a percutaneous biopsy can be performed rapidly, accurately and with greater safety. Unnecessary surgery can often be avoided, thereby reducing patient morbidity, shortening the period of hospitalization and allowing the physician to start treatment according to the biopsy findings alone.

We found an accuracy of 71.4% in the diagnosis of mediastinal lymphoma. Seventy one percent of the patients were treated on the basis of percutaneous core-needle biopsy results alone. We concluded that CT guided core –needle biopsy is a quick, safe and efficient alternative to open or excisional biopsy for diagnosis of mediastinal lymphoma. The use of core needle biopsy and immunocytochemical methods have improved the diagnostic accuracy, and we expect that in the future years the accuracy of this technique will improve even more.

At present I am summarizing our experience with image-guided biopsy of peripheral lymph nodes and superficial masses in the diagnosis of lymphoma.

While it is accepted to use this method on deeply seated lymph nodes, it is not the rule for peripheral lymph nodes .The traditional approach for sampling of peripheral lymph nodes is surgery The purpose of this study is to present the findings of image-guided percutaneous core needle biopsy of peripheral lymph nodes and superficial masses, to evaluate its feasibility and diagnostic reliability in the diagnosis of lymphoma.

Our overall success rate of 74% is in accordance with previous studies for image-guided core needle biopsy of lymphoma in any other part of the body. Treatment of lymphoma was initiated on the basis of image-guided core-needle biopsy in 82% of the patients.

In conclusion, our data challenge the previous reports and indicate that percutaneous image-guided core–needle biopsy should be considered as an alternative to excisional biopsy in patients with peripheral lymphadenopathy or superficial masses for the diagnosis of lymphoma.

Recently we began to evaluate percutaneous biopsies of the spleen in the diagnosis of lymphoma.