FALSE-NEGATIVE RESULTS IN PERCUTANEOUS ADRENAL BIOPSIES IN ONCOLOGY PATIENTS
SIR - We read with much interest the article by Harisinghani et al. [1], in the October 2002 issue of the Clinical Radiology. We agree with the great value of CT-guided adrenal biopsies in oncology patients in whom obtaining benign adrenal tissue is highly predictive of benignity. In addition, we would like to take the opportunity to mention a rare false- negative result of adrenal gland biopsies [2]. From our previous experience [3], we encountered a false-negative result related to a well-differentiated 4 cm adrenocortical carcinoma, which was diagnosed as adenoma on initial biopsy in a 57-year-old patient with lung carcinoma. However, the heterogeneous peripheral enhancement on contrast CT was suspicious enough to lead us to surgically remove this lesion. This represents a classic but rare false-negative result. Adrenal adenoma and adrenocortical carcinoma may be difficult to distinguish histopathologically. The probability that some tumours diagnosed as adenoma may represent small, well differentiated, non-functioning adrenocortical carcinoma is extremely rare in view of the very low prevalence and their usually large
size at presentation. However, when a discrepancy exists between imaging and pathology results, surgical intervention is advocated [2].
B. MESUROLLE F. MIGNON
REFERENCES
1 Harisinghani MG, Maher MM, Hahn PF, et al. Predictive value of benign percutaneous adrenal biopsies in oncology patients. Clin Radiol, 2002; 57:898-901.
2 Katz R, Shirkhoda A. Diagnostic approach to incidental adrenal nodules in cancer patient. Cancer, 1985;55:1995-2000.
3 Mesurolle B, Ariche-Cohen M, Tardivon A, et al. Retrospective analysis of 44 adrenal puncture biopsies under computed tomographic guidance. J Radiol, 1996;77:17-21.
doi:10.1016/S0009-9260(03)00168-5, available online at www.sciencedirect.com
CAN RADIOGRAPHERS READ SCREENING MAMMOGRAMS?
SIR - We read with dismay the well-written and informative paper by Wivell et al. in Clinical Radiology [1]. Our dismay is in no way directed to the authors who have produced an excellent and complete paper. It is directed to the crumbling role of, and regard for, the modern radiologist, particularly in the UK. As the authors point out in their paper, radiographers when adequately trained became competent at reading screening mammo- grams. We suspect nurses, medical students, and others, if adequately trained, could also read screening mammograms.
Conversely, we suspect radiologists, if adequately trained, could produce high quality mammograms and radiographs, operate a computed tomography (CT) or magnetic resonance imaging (MRI) console, or do other professional duties carried out by radiographers. We also suspect that a radiologist could be trained in time to do nursing duties. They do not generally perform these other duties because these are duties that other specialities are trained to do.
The key term in all of this is the word “training”. A radiologist trains typically for at least 10 years from the time they enter medical school to the time they become a consultant. We understand that there is currently a shortage of radiologists in the UK, and this needs to be addressed. If the specialty is to survive, it must preserve its unique role in the professional interpretation of images. Shortages in numbers should be tackled by attracting more trainees into the profession and in particular, into areas of need. Committing professional suicide is not the answer.
W. C. TORREGGIANI S. HAMILTON
REFERENCES
1 Wivell G, Denton ERE, Eve CB, et al. Can radiographers read screening mammograms? Clin Radiol, 2003;58:63-67.
doi:10.1016/S0009-9260(03)00169-7, available online at www.sciencedirect.com
CAN RADIOGRAPHERS READ SCREENING MAMMOGRAMS ?: RESPONSE
SIR - We thank Drs Torreggiani and Hamilton for their comments. We agree that the radiologist has a truly unique role. In breast imaging it is the umbrella knowledge that their 10 or more years of training brings to breast radiology practice that cannot be replaced-particularly in the final decision-making process.
The NHS needs a well-motivated, multidisciplinary workforce at all levels. We believe it is important to give all staff the opportunity to expand both their knowledge base and practice for the benefit of patients, even when this may jeopardize traditional consultant role models.
The current commitment to programme expansion in the National
Health Service Breast Screening Programme cannot be implemented in most centres without some role re-evaluation because of staff shortages. We cannot keep increasing the workload for breast-screening radiologists who have become a very precious commodity.
If we remove some tasks that other staff can be shown to undertake to at least the same standard, then the radiologist will have more time to undertake the tasks that cannot be delegated. It may even provide them with some time to train the health professionals of the future.
E. DENTON
G. WIVELL
C. B. EVE
J. C. INGLIS I. HARVEY