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Li JJX, Chow MBCY, Ng JKM, Tsang JY, Tse GM. Cytomorphological Assessment in Aspirates of Ductal Carcinoma in situ: Correlations with Histopathologic Grade, Architectural Pattern, and Invasion. Acta Cytol 2023; 68:45-53. [PMID: 38128502 PMCID: PMC10994590 DOI: 10.1159/000535836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Fine-needle aspiration biopsy (FNAB) of the breast is an effective and widely adopted diagnostic technique. Histopathologic grading of ductal carcinoma in situ (DCIS) has prognostic significance. In this current study, FNAB of DCIS was reviewed to identify parameters that predict grading, histopathologic architecture, and presence of invasion in DCIS. METHODS Aspirates from histopathology-proven cases of DCIS were retrieved and reviewed for cytomorphologic parameters including cellularity, composition, epithelial fragment architecture cellular/nuclear features. RESULTS In total 104 aspirates were reviewed. Cytopathologic cellular features - large nuclear size (p = 0.005), prominent nucleoli (p = 0.011), increased nuclear membrane irregularity (p = 0.043), high variation in nuclear size (p = 0.025), and presence of apoptotic figures in epithelial structures (p < 0.001); and background debris (p = 0.033) correlated with a high-grade diagnosis. Cytoplasmic vacuolation (p = 0.034) was seen exclusively in non-high-grade aspirates. Epithelial fragment architecture did not correlate with grading. A predominance (≥50%) of solid aggregates and papillary fragments on FNAB correlated with histopathologically solid (p = 0.039, p = 0.005) and papillary (p = 0.029, < p = 0.001) patterns. No parameter showed correlation with invasion. CONCLUSION FNAB is effective in predicting DCIS grading. Epithelial fragment architecture assessment is limited to papillary or solid types, and FNAB cannot predict focal invasion in DCIS.
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MESH Headings
- Humans
- Female
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/chemistry
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Breast/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/pathology
- Biopsy, Fine-Needle
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Carcinoma in Situ/pathology
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Affiliation(s)
- Joshua J X Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China,
| | - Maria B C Y Chow
- Department of Pathology, North District Hospital, Sheung Shui, New Territories, Hong Kong, China
| | - Joanna K M Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
| | - Julia Y Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
- Department of Pathology, North District Hospital, Sheung Shui, New Territories, Hong Kong, China
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Md Nasir ND, Koh VCY, Cree IA, Ruiz BII, Del Águila J, Armon S, Fox SB, Lakhani SR, Tan PH. Phyllodes tumour evidence gaps mapped from the 5th edition of the WHO classification of tumours of the breast. Histopathology 2023; 82:704-712. [PMID: 36579383 DOI: 10.1111/his.14856] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/21/2022] [Accepted: 12/24/2022] [Indexed: 12/30/2022]
Abstract
AIMS Breast phyllodes tumours (PTs) are a rare subset of fibroepithelial neoplasms categorised into benign, borderline, and malignant grades according to the World Health Organization (WHO) Classification of Tumours (WCTs). In this report, we developed an evidence gap map (EGM) based on the literature cited in the PT chapter of the 5th edition of the breast WCT in order to identify knowledge and research gaps in PT. METHODS A framework was first established where the dimensions of the EGM were defined as categories of tumour descriptors, tumour types, and evidence levels. Citations were collected into a Microsoft Excel form and imported into EPPI-reviewer to produce the EGM. RESULTS The EGM showed that the "Histopathology" and "Pathogenesis" sections contained the most citations, the majority being of low-level evidence. The highest number of citations considered of moderate-level evidence were found in the "Histopathology" section. There was no high-level evidence cited in this chapter. The "Localisation", "Aetiology", and "Staging" sections had the fewest citations. CONCLUSION This EGM provides a visual representation of the cited literature in the PT chapter of the breast WCT, revealing the lack of high-level evidence citations. There is an uneven distribution of references, probably due to citation practices. Pockets of low-level evidence are highlighted, possibly related to referencing habits, lack of relevant research, or the belief that the information presented is standard accepted fact, without the need for specific citations. Future work needs to bridge evidence gaps and broaden citations beyond those in the latest WCT.
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Affiliation(s)
- Nur Diyana Md Nasir
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Valerie C Y Koh
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Ian A Cree
- WHO/IARC Classification of Tumours, International Agency for Research on Cancer (IARC), Lyon, France
| | - Blanca I I Ruiz
- WHO/IARC Classification of Tumours, International Agency for Research on Cancer (IARC), Lyon, France
| | - Javier Del Águila
- WHO/IARC Classification of Tumours, International Agency for Research on Cancer (IARC), Lyon, France
| | - Subasri Armon
- WHO/IARC Classification of Tumours, International Agency for Research on Cancer (IARC), Lyon, France
| | - Stephen B Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sunil R Lakhani
- University of Queensland Centre for Clinical Research and Pathology, Brisbane, QLD, Australia
| | - Puay Hoon Tan
- Luma Medical Centre, Singapore, Singapore
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
- Department of Pathology, University of Western Sydney, Sydney, Australia
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Same day estrogen, progesterone and HER2neu receptor assessment in breast cancer diagnosis using Core Wash Cytology. Surg Oncol 2023; 47:101919. [PMID: 36863065 DOI: 10.1016/j.suronc.2023.101919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/01/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
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Heidari F, Heidari F, Najafi MS, Ansari R, Aghazadeh K, Sohrabpour S, Karimi E. Core Needle Biopsy in Suspicious Malignant Thyroid Nodules with Repeated Nondiagnostic Fine Needle Aspiration. Indian J Otolaryngol Head Neck Surg 2022; 74:2071-2075. [PMID: 36452564 PMCID: PMC9702104 DOI: 10.1007/s12070-020-02011-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022] Open
Abstract
Key message The clinician could have CNB in mind for thyroid nodules when FNA results were nondiagnostic. Our study would suggest CNB a safe and efficient method for investigating thyroid nodules. Abstract Usefulness of preoperative tissue sampling and pathology diagnoses in thyroid tumors were accepted worldwide. We investigate the role of Core needle biopsy (CNB) in the thyroid nodules lesions when FNA results are nondiagnostic. We conducted a cross-sectional study to evaluate twenty-six CNBs results of suspicious malignant thyroid nodules with nondiagnostic repeated fine needle aspiration. 25 from 26 CNBs were diagnostic. Twenty-one needle biopsy reports were papillary thyroid carcinoma, three CNB samples diagnosed medullary thyroid carcinoma and one of them had anaplastic results. All diagnostic needle biopsies results were compatible with final pathology. Our study would suggest CNB a safe and efficient method for investigating thyroid nodules while repeated FNA yielded nondiagnostic results.
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Affiliation(s)
- Farrokh Heidari
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
| | - Firouzeh Heidari
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
| | - Mohammad Sadeq Najafi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
| | - Reza Ansari
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
| | - Kayvan Aghazadeh
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
| | - Saeed Sohrabpour
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
| | - Ebrahim Karimi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir Alam Hospital, North Sadi Ave, Tehran, 1145765111 Iran
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Chan RCK, Lee ALS, To CCK, Cheung TLH, Ho CT, Choi JSH, Li JJX. The role of cytokeratin 7/20 coordination revisited-Machine learning identifies improved interpretative algorithms for cell block immunohistochemistry in aspirates of metastatic carcinoma. Cancer Cytopathol 2022; 130:455-468. [PMID: 35213075 DOI: 10.1002/cncy.22559] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Fine-needle aspiration (FNA) is a robust diagnostic technique often used for tissue diagnosis of metastatic carcinoma. For interpretation of FNA cytology, cell block immunohistochemistry (IHC) and clinicocytologic parameters are indispensable. In this review of a large cohort, the current report: 1) describes clinicocytologic parameters and immunoprofiles of aspirates of metastatic carcinoma, 2) compares the predictivity of immunostains and classical approaches for IHC interpretation, and 3) describes machine learning-based algorithms for IHC interpretation. METHODS Aspirates of metastatic carcinoma that had IHC performed were retrieved. Clinicocytologic parameters, IHC results, the corresponding primary site, and histologic diagnoses were recorded. By using machine learning, decision trees for predicting the primary site were generated, their performance was compared with 2 human-designed algorithms, and the primary site was suggested in the historical diagnosis. RESULTS In total, 1145 cases were identified. The 6 most populated groups were selected for machine learning and predictive analysis. With IHC input, the decision tree achieved a concordance rate of 94.5% and overall accuracy of 83.6%, which improved to 95.3% and 85.8%, respectively, when clinical data were incorporated and exceeded the human-designed IHC algorithms (P < .001). The historical diagnosis was more accurate unless indeterminate diagnoses were regarded as discordant (P < .001). CDX2 and TTF-1 immunostains had the highest weight in model accuracy, occupied the root of the decision trees, scored higher as features of importance, and outperformed the predictive power of cytokeratins 7 and 20. CONCLUSIONS Cytokeratins 7 and 20 may be superseded in immunostaining panels, including organ-specific immunostains such as CDX2 and TTF-1. Machine learning generates algorithms that surpasses human-designed algorithms but is inferior to expert assessment integrating clinical and cytologic assessment.
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Affiliation(s)
- Ronald Cheong Kin Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Angus Lang Sun Lee
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Curtis Chun Kit To
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tommy Lok Him Cheung
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ching Ting Ho
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Joseph Sen Hei Choi
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Joshua Jing Xi Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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6
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González Mariño MA. Inter-observer agreement in the diagnosis of breast atypical ductal hyperplasia: A systematic review. Breast Dis 2022; 41:545-550. [PMID: 36683493 DOI: 10.3233/bd-220029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To review the concordance between pathologists in the diagnosis of atypical ductal hyperplasia of the breast. METHODS Systematic review of articles registered in the PubMed database with the terms "pathologists" and "atypical ductal hyperplasia", "atypical ductal hyperplasia" and "interobserver variability", in Embase with "interobserver agreement in atypical ductal hyperplasia" and Lilacs with the terms in Spanish "patólogos" and "hiperplasia ductal atípica", without the use of filters, between 03/16/2022 and 03/26/2022 searching for articles that assess inter-observer agreement in the diagnosis of atypical ductal hyperplasia by using the kappa statistic. Review articles, conference proceedings, and commentaries were excluded. RESULTS With the search terms, 507 publications were found. Of these, 491 were excluded from the screening by title and abstract. Of the full reading of the remaining articles, 6 were selected for qualitative analysis. The kappa values ranged from slight agreement, kappa = 0.17, to substantial agreement, 0.69 obtained from pathologists dedicated or experienced in breast pathology and who received a prior tutorial session to review the general criteria for atypia. CONCLUSIONS This study reviews the reproducibility in the diagnosis of atypical ductal hyperplasia. A better concordance was obtained with a previous teaching process offered to pathologists dedicated or experienced in breast pathology.
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Affiliation(s)
- Mario Arturo González Mariño
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, D.C, Colombia
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7
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Marabi M, Aphivatanasiri C, Jamidi SK, Wang C, Li JJ, Hung EH, Poon IK, Tsang JY, Tse GM. The International Academy of Cytology Yokohama System for Reporting Breast Cytopathology showed improved diagnostic accuracy. Cancer Cytopathol 2021; 129:852-864. [PMID: 34029453 DOI: 10.1002/cncy.22451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of the International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology is to improve cytology practice. This study assessed cytologic diagnoses made with the system and its efficacy when it was applied by pathologists with different levels of experience. METHODS In all, 1080 cases of breast fine-needle aspiration biopsy (FNAB) over a period of 16 years were reviewed and reclassified with the system. The category distribution and the diagnostic performance were compared with the original diagnoses. The concordance rates for diagnoses from pathologists with different levels of experience were also determined. RESULTS The distribution of cytologic diagnoses made with the system was as follows: 11.7% were insufficient, 56.6% were benign, 20.1% were atypical, 6.1% were suspicious for malignancy, and 5.6% were malignant. The rates for the insufficient and atypical categories were lower than the original diagnosis rates (13.1% and 23.8%, respectively). Overall, 120 cases (11.1%) were recategorized. Among those recategorized as benign, suspicious, or malignant with follow-up data, 96.7% were correctly reclassified. A significant improvement in diagnostic performance was found with the system (P < .001). Such improvement was also seen in problematic breast lesions, including fibroepithelial lesions, papillary lesions, and low-grade carcinomas. Pathologists with intermediate experience showed a higher concordance with an expert pathologist in the diagnoses than those with short experience (κ, 0.838 vs 0.634). CONCLUSIONS The system effectively categorized the diagnoses, and the diagnostic performance of FNAB reporting was improved. The structured reporting also enhanced the reproducibility of reporting by pathologists with intermediate experience and, to some extent, those with short experience.
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Affiliation(s)
- Monalyn Marabi
- Department of Pathology, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | | | | | - Chao Wang
- Department of Pathology, Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Joshua J Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Esther H Hung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Ivan K Poon
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Julia Y Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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8
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Li Z, Souers RJ, Tabbara SO, Natale KE, Nguyen LN, Booth CN. Breast Fine-Needle Aspiration Practice in 2019: Results of a College of American Pathologists National Survey. Arch Pathol Lab Med 2020; 145:825-833. [PMID: 33351901 DOI: 10.5858/arpa.2020-0408-cp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The College of American Pathologists surveys provide national benchmarks of pathology practice for laboratories. OBJECTIVE.— To investigate breast fine-needle aspiration (FNA) biopsy practice in domestic and international laboratories in 2019. DESIGN.— We analyzed data from the College of American Pathologists Breast FNA Practice Supplemental Questionnaire that was distributed to laboratories participating in the 2019 College of American Pathologists Non-Gynecologic Cytopathology Education Program. RESULTS.— Sixty-one percent (499 of 816) of respondent laboratories routinely evaluated breast FNAs. Cystic lesions were the most common indication, and radiologists primarily performed FNAs in most settings. Forty-five percent (220 of 491) of laboratories performed ancillary studies on breast FNA samples, but 33.8% (70 of 207) did not report fixation time for breast biomarker studies. Only 54.5% (271 of 497) of laboratories had a standardized reporting system and only 16.8% (82 of 488) were aware of the International Academy of Cytology Yokohama Breast FNA Biopsy Cytology Reporting System. There were significant differences among different types of institutions in several aspects of breast FNA practice, including frequency of concurrent FNA and core needle biopsy for the same lesion, primary personnel who performed the FNA, etc. Significant differences existed between domestic and international laboratories in slide preparation, ancillary studies, fixation time reporting, standardized/descriptive diagnosis, and International Academy of Cytology Yokohama Reporting System awareness. CONCLUSIONS.— This is the first survey from the College of American Pathologists Cytopathology Committee to investigate breast FNA practices. The data reveal significant differences in breast FNA practice among different types of institutions and between domestic and international laboratories, and provide a baseline for future breast FNA studies in a variety of practice settings.
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Affiliation(s)
- Zaibo Li
- From the Department of Pathology, Ohio State University Medical Center, Columbus (Li)
| | - Rhona J Souers
- Biostatistics, College of American Pathologists, Northfield, Illinois (Souers)
| | - Sana O Tabbara
- The Department of Pathology, The George Washington University, Washington, DC (Tabbara)
| | - Kristen E Natale
- The Department of Pathology, Holy Cross Hospital, Silver Spring, Maryland (Natale)
| | - Lananh N Nguyen
- The Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Nguyen)
| | - Christine N Booth
- From the Department of Pathology, Ohio State University Medical Center, Columbus (Li).,The Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Booth)
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9
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de Cursi JAT, Marques MEA, de Assis Cunha Castro CAC, Schmitt FC, Soares CT. Fine-Needle Aspiration Cytology (FNAC) is a reliable diagnostic tool for small breast lesions (≤ 1.0 cm): a 20-year retrospective study. SURGICAL AND EXPERIMENTAL PATHOLOGY 2020. [DOI: 10.1186/s42047-020-00081-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Breast cancer is a major public health problem worldwide. It is recommended that small breast lesions or those suspicious for malignancy be evaluated via histopathological examination (“core biopsy” or surgical specimens), and lesions that are probably benign and palpable should be examined via fine-needle aspiration cytology (FNAC). This study aimed to assess the accuracy of FNAC for the diagnosis of small breast lesions.
Methods
We reviewed all anatomopathological reports of FNACs collected between January 1, 2000 and December 31, 2019 (n = 24,721) in a private community pathology service. Lesions up to 1.0 cm (≤1.0 cm) (n = 8334) were included for evaluation and classified according to the recommendation of the International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology in the following categories: (1) insufficient/inadequate; (2) benign; (3) atypical, probably benign; (4) suspicious of malignancy; and (5) malignant. Subsequently, the results of the FNACs were compared to those of the respective histopathological examinations (n = 785).
Results
FNAC had a specificity of 99.6%; sensitivity, 97.4%; positive predictive value, 99.6%; negative predictive value, 97.6%; and accuracy, 98.5%.
Conclusions
FNAC is a reliable method for diagnosing small breast lesions (≤1.0 cm).
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Wang Y, Liu D, Wu Z. Ultrasound May Help Detect Chest Wall Recurrence After Mastectomy at an Early Stage. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2339-2349. [PMID: 32436597 DOI: 10.1002/jum.15343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To define ultrasound (US) features that help diagnose local recurrence (LR) and differentiate benign masses from LR chest wall masses after mastectomy in patients with breast cancer. METHODS The US and surgical records of 119 pathologically confirmed chest wall masses in 101 patients were reviewed from 4634 patients with breast cancer who underwent mastectomies. The chest wall masses were divided into 2 groups depending on their longitudinal diameter (LD; ≤10 and > 10 mm). The US features of the subgroups, depending on their nature (benign and LR), were analyzed and compared. RESULTS Among 119 masses, 58 (48.74%) were benign masses, and 61 (51.26%) were LR masses. For LR, the mean area under the curve ± SD, sensitivity, and specificity of US were 0.849 ± 0.033, 85.25%, and 84.48% (P < .001), respectively. Among the US characteristics, vascularity, an irregular shape, and a location in deep layers were the top 3 factors related to LR (odds ratios, 4.0, 2.6, and 2.2). To diagnose LR by US, judging the anatomic layer of the locations of masses with an LD of 10 mm or less and the presence of vascularity in masses with an LD of greater than 10 mm were helpful. CONCLUSIONS Ultrasound is a relatively accurate and objective method to differentiate LR from a benign mass after mastectomy with follow-up. Judging the anatomic layer of the mass location with US likely increases the accuracy of LR diagnosis at an early stage.
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Affiliation(s)
- Ying Wang
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Danru Liu
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhifeng Wu
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
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11
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Li JJ, Chan W, Chau HH, Wu C, Tse GM. Cytologic diagnosis of metastatic malignant phyllodes tumor of the breast in pleural effusion. Diagn Cytopathol 2019; 47:599-602. [DOI: 10.1002/dc.24151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/04/2019] [Accepted: 01/15/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Joshua J.X. Li
- Department of Anatomical and Cellular PathologyPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - W.C. Chan
- Department of SurgeryNorth District Hospital Sheung Shui, New Territories Hong Kong
| | - Helen H.L. Chau
- Department of Imaging and Interventional RadiologyPrince of Wales Hospital New Territories Hong Kong
| | - Cherry Wu
- Department of PathologyNorth District Hospital Sheung Shui, New Territories Hong Kong
| | - Gary M. Tse
- Department of Anatomical and Cellular PathologyPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
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12
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McLaughlin CM, Gonzalez-Hernandez J, Bennett M, Piper HG. Pediatric breast masses: an argument for observation. J Surg Res 2018; 228:247-252. [DOI: 10.1016/j.jss.2018.03.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/24/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
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13
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Alwahaibi N, Albadi H, Almasrouri N, Alsinawi S, Aldairi N. Immunocytochemical evaluation of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 in breast cancer cell blocks and corresponding tissue blocks: A single institutional experience. JOURNAL OF MEDICAL SCIENCES 2018. [DOI: 10.4103/jmedsci.jmedsci_130_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Łukasiewicz E, Ziemiecka A, Jakubowski W, Vojinovic J, Bogucevska M, Dobruch-Sobczak K. Fine-needle versus core-needle biopsy - which one to choose in preoperative assessment of focal lesions in the breasts? Literature review. J Ultrason 2017; 17:267-274. [PMID: 29375902 PMCID: PMC5769667 DOI: 10.15557/jou.2017.0039] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/10/2017] [Accepted: 09/14/2017] [Indexed: 11/22/2022] Open
Abstract
Aim The aim of the study was to review two techniques that can be used to verify focal lesions in the breasts: fine-needle aspiration biopsy and core-needle biopsy. Material and methods Fifty-five articles (original papers and reviews), half of them published within the past 5 years, were included in the analysis. The authors also took their own experience into account. Results Pre-operative assessment of focal lesions in the breasts is crucial in the planning of further therapeutic management. The role of fine-needle aspiration biopsy has been reduced lately due to its low sensitivity and specificity as well as a high rate of non-diagnostic, suspicious and false negative results. This method does not enable one to differentiate between in situ and invasive disease. Currently, fine-needle biopsy is recommended for cystic lesions, suspected of being recurrences in the chest wall, and lymph node metastases. Core-needle biopsy is the basic diagnostic method of breast lesions. According to the recommendations of the Polish Ultrasound Society and American College of Radiology, BIRADS 4 and 5 lesions should be evaluated histopathologically. Core-needle biopsy makes it possible to establish a final diagnosis more frequently than fine-needle biopsy, both in the case of benign and malignant lesions. It delivers more information about the nature of a tumor (mutation of HER-2, estrogen and progesterone receptors and Ki-67 index). Its limitations include: underestimation of invasion and failure to recognize the components of ductal carcinoma in situ in papillary and atypical lesions. Single fine-needle aspiration biopsy is inexpensive, but when considering the cost of further diagnosis due to non-diagnostic, suspicious and atypical results, this method generates high additional costs. Conclusions Microscopic verification of focal breast lesions is crucial for further therapeutic decisions. It has been proven that histopathological verification is more accurate and has more advantages than cytological assessment.
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Affiliation(s)
- Ewa Łukasiewicz
- Department of Medical Imaging, Mazovia Brodnowski Hospital, Warsaw, Poland
| | - Agnieszka Ziemiecka
- Department of Ultrasonography and Mammography, Mazovia Brodnowski Hospital, Warsaw, Poland
| | - Wiesław Jakubowski
- Department of Ultrasonography and Mammography, Mazovia Brodnowski Hospital, Warsaw, Poland
| | - Jelena Vojinovic
- Department of Pediatric Rheumatology, Clinical Center, Faculty of Medicine, University of Nis, Serbia
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Abstract
Fibroepithelial breast lesions encompass a heterogeneous group of neoplasms that range from benign to malignant, each exhibiting differing degrees of stromal proliferation in relation to the epithelial compartment. Fibroadenomas are common benign neoplasms that may be treated conservatively. Phyllodes tumors are relatively rare lesions, and classified as benign, borderline, or malignant based on histologic evaluation of various parameters. The diagnostic interpretation of "gray-zone" fibroepithelial lesions often imposes formidable demands on a pathologist's skills. This article offers practical recommendations for the diagnostic workup of these lesions, including the appropriate utilization of ancillary investigations and the approach to core needle biopsies.
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Yu SN, Li J, Wong SI, Tsang JYS, Ni YB, Chen J, Tse GM. Atypical aspirates of the breast: a dilemma in current cytology practice. J Clin Pathol 2017; 70:1024-1032. [DOI: 10.1136/jclinpath-2016-204138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 11/04/2022]
Abstract
AimsThe probabilistic approach is widely adopted for breast fine needle aspiration cytology. However, a definite cytological diagnosis is not always possible for C3 (atypia) cases, which poses a management dilemma as this represents a mixed category of benign and malignant cases. It would be beneficial to be able to predict malignancy based on specific cytological features in C3 aspirates.MethodsA comprehensive panel of cytological features (including quantitative, cytomorphological and background features) in a large cohort of C3 breast aspirates with subsequent histological excisions was evaluated to identify relevant morphological criteria predicting the risk of subsequent malignancy.ResultsA total of 229 C3 specimens with histological follow-up were included. Malignant outcome was found in 30.1% of specimens and the majority were invasive cancers. Features that showed a significant association with malignant outcome included older age (p=0.001), lower percentage of epithelial cell clusters and high percentage of single cells (p=0.002), cribriform architecture in cell clusters (p=0.034), presence of intracellular mucin (p=0.027), increased cell clusters without myoepithelial cells (p=0.048), diminished fibromyxoid stromal fragments (p=0.001), reduced bipolar nuclei (p=0.021) and the presence of necrosis (p=0.023). Except for the percentages of single cells and cell clusters without myoepithelial cells, all other features were shown to be independent risk predictors in multivariate analysis.ConclusionsC3 aspirates were associated with a significant probability of histological malignancy. Certain quantitative, cytomorphological and background features were potentially helpful in predicting the risk of a malignant outcome. The prediction could be clinically useful in the management of C3 cases.
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17
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Affiliation(s)
- Hans Blom
- Royal Institute of Technology (KTH), Dept Applied Physics, SciLifeLab, 17165 Solna, Sweden
| | - Jerker Widengren
- Royal Institute of Technology (KTH), Dept Applied Physics, Albanova Univ Center, 10691 Stockholm, Sweden
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18
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A sensitivity and specificity comparison of fine needle aspiration cytology and core needle biopsy in evaluation of suspicious breast lesions: A systematic review and meta-analysis. Breast 2017; 31:157-166. [DOI: 10.1016/j.breast.2016.11.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 11/18/2022] Open
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19
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Kim EY, Hyun KH, Park YL, Park CH, Do SI. Predictors for the Transition from Ductal Carcinoma <i>In Situ</i> to Invasive Breast Cancer in Korean Patients. ACTA ACUST UNITED AC 2016. [DOI: 10.14449/jbd.2016.4.1.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Kocaay AF, Celik SU, Sevim Y, Ozyazici S, Cetinkaya OA, Alic KB. The role of fine needle aspiration cytology and core biopsy in the diagnosis of palpable breast masses. Niger Med J 2016; 57:77-80. [PMID: 27226679 PMCID: PMC4872495 DOI: 10.4103/0300-1652.182078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: The modern approach to palpable breast masses is to get cytopathologic diagnosis before definitive surgery. We aimed to compare fine needle aspiration cytology (FNAC) with core biopsy in histopathologic diagnosis of palpable breast masses. Materials and Methods: Data were collected on 123 women who have suspicious palpable breast masses from 2007 to 2010. Results: Of the 123 patients, core biopsies were performed on 64 patients (Group 1) and FNAC on 59 patients (Group 2). Malignancy was confirmed in 25 out of 32 clinically suspicious patients in Group 1 (78.1%), and 20 out of 21 participants in Group 2 (95.2%). Among the clinically suspicious patients, 81.8% of 33 patients in Group 1, and 90.3% of 31 patients in Group 2 were identified malignancy. Sensitivity was 100% for core biopsy and 95% for FNAC. Specificity was 100% in both procedures. False negativity rate in FNAC were 5%. Conclusion: Sensitivity and specificity showed that in the case of true histopathologic classification, core biopsy is superior to FNAC. Nevertheless, FNAC's role as a fast, simple and cheap diagnosis cannot be ignored. It is an effective diagnostic tool in most patients, in comparison to the correct and specific typing of core biopsies in benign lesions which protect patients from the open biopsy.
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Affiliation(s)
- Akin Firat Kocaay
- Department of General Surgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Suleyman Utku Celik
- Department of General Surgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Yusuf Sevim
- Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Sefa Ozyazici
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Omer Arda Cetinkaya
- Department of General Surgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Kamil Bulent Alic
- Department of General Surgery, School of Medicine, Ankara University, Ankara, Turkey
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21
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Aker F, Gümrükçü G, Onomay BÇ, Erkan M, Gürleyik G, Kiliçoğlu G, Karagüllü H. Accuracy of fine-needle aspiration cytology in the diagnosis of breast cancer a single-center retrospective study from Turkey with cytohistological correlation in 733 cases. Diagn Cytopathol 2015; 43:978-86. [DOI: 10.1002/dc.23380] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/05/2015] [Accepted: 09/24/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Fügen Aker
- Department of Pathology; Haydarpaşa Numune Education and Research Hospital; Istanbul Turkey
| | - Gülistan Gümrükçü
- Department of Pathology; Haydarpaşa Numune Education and Research Hospital; Istanbul Turkey
| | - Burcu Çelik Onomay
- Department of Pathology; Haydarpaşa Numune Education and Research Hospital; Istanbul Turkey
| | - Murat Erkan
- Department of Pathology; Haydarpaşa Numune Education and Research Hospital; Istanbul Turkey
| | - Günay Gürleyik
- Department of Surgery; Haydarpaşa Numune Education and Research Hospital; Istanbul Turkey
| | - Gamze Kiliçoğlu
- Department of Radiology; Haydarpaşa Numune Education and Research Hospital; Istanbul Turkey
| | - Hikmet Karagüllü
- Department of Radiology; Haydarpaşa Numune Education and Research Hospital; Istanbul Turkey
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22
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Wyss P, Varga Z, Rössle M, Rageth CJ. Papillary lesions of the breast: outcomes of 156 patients managed without excisional biopsy. Breast J 2014; 20:394-401. [PMID: 24861903 DOI: 10.1111/tbj.12283] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Papillomas of the breast are benign epithelial neoplasms. Because of the low, but continued potential for malignancy, the treatment options after initial diagnosis remain controversial. The aim of this study was to analyze the clinical course of patients with papilloma who were managed by active surveillance following initial diagnosis by core needle biopsy or vacuum-assisted biopsy. This retrospective study analyzed 174 patients with 180 papillomas that were diagnosed by core needle biopsy (113 cases) or vacuum-assisted biopsy (67 cases) at the Breast Center Seefeld Zurich between February 2002 and May 2011. We excluded 24 cases that underwent excisional biopsy for removal of the lesion. Over a mean follow-up of 3.5 years, 13 further events occurred in 156 cases (8%). These events included two cases of ductal carcinoma in situ (one after 4 and one after 6 years), one case of atypical ductal hyperplasia, one radial scar, eight cases of papilloma, and one case of flat epithelial atypia. No invasive carcinomas occurred during the follow-up period. Conservative management of 156 papillary lesions with removal by vacuum-assisted biopsy and surveillance was not associated with invasive cancer over a median follow-up of 3.5 years. Therefore, this approach seems to be a safe option for the clinical management of papillary lesions.
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23
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Radhakrishna S, Gayathri A, Chegu D. Needle core biopsy for breast lesions: An audit of 467 needle core biopsies. Indian J Med Paediatr Oncol 2014; 34:252-6. [PMID: 24604953 PMCID: PMC3932591 DOI: 10.4103/0971-5851.125237] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Breast cancer is the commonest cancer among women in urban India. Triple assessment includes clinical, radiological and cytological assessment of breast lesions. Guided core needle biopsy has replaced fine needle aspiration cytology in most of the western countries. In resource poor countries FNAC is still a very valuable and cost effective method to diagnose breast lesions. Pitfalls include increased rates of non diagnostic smears, and inadequate smears. Further procedures may be required and this increases the cost, anxiety and delay in diagnosis. Aims: The aim of this study is to analyze the concordance of radiological and histopathology findings in BI-RADS category 3,4,5 lesions following a core biopsy. Materials and Methods: Data was retrospectively collected from consecutive symptomatic and opportunistic screen detected patients with abnormalities who underwent ultrasound guided interventional procedures from Jan 2010 to Aug 2011. Symptomatic patients underwent clinical examination, mammogram and breast ultrasound. Women under 35 years of age had only breast ultrasound. Core biopsy was performed under ultrasound guidance or clinically by a breast surgeon/ radiologist for BI-RADS category 3,4,5 lesions. Statistical Methods: Chi square test was done to show the strength of association of imaging findings and histopathology results of core biopsy. Results: 437 patients were symptomatic and 30 patients had screen detected abnormalities. The positive predictive value for BI-RADS 5 lesions for malignancy is 93.25% and the negative predictive value of BI-RADS category 3 lesions for cancer is 98.4%. False negative diagnosis on core biopsy was 0.85%. We were able to defer surgery in 60% of the patients with a clear radiological and pathological benign diagnosis. Conclusion: The PPV and NPV for cancer is high with needle core biopsy in BI-RADS 3,4,5 lesions. Where there is no discordance between clinical, radiology and pathology findings, surgery can be avoided in benign lesions. While in resource poor countries FNAC continues to be a valuable method in the diagnosis of palpable and non palpable breast lesions, the practice of needle core biopsy provides the most accurate and optimal diagnostic information.
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Affiliation(s)
- Selvi Radhakrishna
- Department of Breast Surgery and Breast Imaging, Chennai Breast Centre, Chennai, Tamil Nadu, India
| | - Anu Gayathri
- Department of Breast Surgery and Breast Imaging, Chennai Breast Centre, Chennai, Tamil Nadu, India
| | - Deepa Chegu
- Department of Breast Surgery and Breast Imaging, Chennai Breast Centre, Chennai, Tamil Nadu, India
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Rönnlund D, Gad AKB, Blom H, Aspenström P, Widengren J. Spatial organization of proteins in metastasizing cells. Cytometry A 2013; 83:855-65. [DOI: 10.1002/cyto.a.22304] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 03/06/2013] [Accepted: 04/12/2013] [Indexed: 01/26/2023]
Affiliation(s)
- Daniel Rönnlund
- Department of Experimental Biomolecular Physics/Applied Physics; KTH-Royal Institute of Technology; AlbaNova University Center; Stockholm; Sweden
| | - Annica K. B. Gad
- Department of Microbiology; Tumor and Cell Biology; Karolinska Institutet; Stockholm; Sweden
| | - Hans Blom
- Department of Experimental Biomolecular Physics/Applied Physics; KTH-Royal Institute of Technology; AlbaNova University Center; Stockholm; Sweden
| | - Pontus Aspenström
- Department of Microbiology; Tumor and Cell Biology; Karolinska Institutet; Stockholm; Sweden
| | - Jerker Widengren
- Department of Experimental Biomolecular Physics/Applied Physics; KTH-Royal Institute of Technology; AlbaNova University Center; Stockholm; Sweden
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25
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Lai HW, Wu HK, Kuo SJ, Chen ST, Tseng HS, Tseng LM, Chen DR. Differences in accuracy and underestimation rates for 14- versus 16-gauge core needle biopsies in ultrasound-detectable breast lesions. Asian J Surg 2013; 36:83-8. [PMID: 23522760 DOI: 10.1016/j.asjsur.2012.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 07/16/2012] [Accepted: 09/06/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/OBJECTIVE Core needle biopsy (CNB) was widely used in the diagnosis of ultrasound-detectable breast lesions. We aimed at assessing the diagnostic performance differences between 14- and 16-gauge ultrasound-guided core biopsies. METHODS This retrospective study enrolled patients receiving CNB from January 2001 to December 2007. The results of 14- and 16-gauge breast CNBs were compared with pathology reports of open surgical biopsy (OSB). RESULTS A total of 1024 paired CNB and OSB results were obtained from 1732 CNB procedures in 1630 patients.Those CNB results reached 92.9% sensitivity, 99.7% specificity, 5.96% underestimation, and 94.8% accuracy rates. There was no difference in sensitivity (p=0.17) or specificity (p=0.38) between 14- and 16-gauge needles. However, better overall accuracy (p=0.02), less underestimation (p<0.001), and lower false-negative (p=0.02) rates were found for the 14-gauge CNB. CONCLUSION Regarding accuracy and underestimation rates, a 14-gauge needle is preferred to a 16-gauge one in ultrasound-guided biopsies.
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Affiliation(s)
- Hung-Wen Lai
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
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26
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Preoperative diagnosis of non-palpable breast lesions. Indian J Surg 2012; 73:388-9. [PMID: 23024554 DOI: 10.1007/s12262-011-0326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 06/02/2011] [Indexed: 10/18/2022] Open
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27
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Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision. Breast 2012; 21:641-5. [DOI: 10.1016/j.breast.2012.06.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/09/2012] [Accepted: 06/20/2012] [Indexed: 11/19/2022] Open
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28
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YAMAGUCHI RIN, TSUCHIYA SHINICHI, KOSHIKAWA TAKASHI, ISHIHARA AKINORI, MASUDA SHINOBU, MAEDA ICHIRO, TAKIMOTO MASAFUMI, KAWAMOTO MASASHI, SATOH HARUAKI, NARITA MICHIHIKO, ITOH HITOSHI, KITAMURA TAKASHI, TSUDA YOSHIKO, OGANE NAOKI, ABE EIJI, IKEDA KATSUHIDE, NAKAMURA TAKESHI, KAMAGUCHI HARUMI, TOKORO YOSHIRO. Diagnostic accuracy of fine-needle aspiration cytology of the breast in Japan: Report from the Working Group on the Accuracy of Breast Fine-Needle Aspiration Cytology of the Japanese Society of Clinical Cytology. Oncol Rep 2012; 28:1606-12. [DOI: 10.3892/or.2012.2014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 07/10/2012] [Indexed: 11/05/2022] Open
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29
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Yamaguchi R, Tsuchiya SI, Koshikawa T, Yokoyama T, Mibuchi K, Nonaka Y, Ito S, Higuchi H, Nagao M, Higaki K, Watanabe J, Kage M, Yano H. Evaluation of inadequate, indeterminate, false-negative and false-positive cases in cytological examination for breast cancer according to histological type. Diagn Pathol 2012; 7:53. [PMID: 22607447 PMCID: PMC3502405 DOI: 10.1186/1746-1596-7-53] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 05/01/2012] [Indexed: 12/02/2022] Open
Abstract
Background We previously investigated the current status of breast cytology cancer screening at seven institutes in our area of southern Fukuoka Prefecture, and found some differences in diagnostic accuracy among the institutions. In the present study, we evaluated the cases involved and noted possible reasons for their original cytological classification as inadequate, indeterminate, false-negative and false-positive according to histological type. Methods We evaluated the histological findings in 5693 individuals who underwent cytological examination for breast cancer (including inadequate, indeterminate, false-negative and false-positive cases), to determine the most common histological types and/or features in these settings and the usefulness/limitations of cytological examination for the diagnosis of breast cancer. Results Among 1152 cytologically inadequate cases, histology revealed that 75/173 (43.6%) cases were benign, including mastopathy (fibrocystic disease) in 38.6%, fibroadenoma in 24.0% and papilloma in 5.3%. Ninety-five of 173 (54.9%) cases were histologically malignant, with scirrhous growing type, invasive ductal carcinoma (SIDC) being significantly more frequent (49.5%) than papillotubular growing type (Papi-tub) (P < 0.0001), solid-tubular growing type (P = 0.0001) and ductal carcinoma in situ (DCIS) (P = 0.0001). Among 458 indeterminate cases, 54/139 (38.8%) were histologically benign (mastopathy, 30.0%; fibroadenoma, 27.8%; papilloma, 26.0%) and 73/139 (52.5%) were malignant, with SIDC being the most frequent malignant tumor (37.0%). Among 52 false-negative cases, SIDC was significantly more frequent (42.3%) than DCIS (P = 0.0049) and Papi-tub (P = 0.001). There were three false-positive cases, with one each of fibroadenoma, epidermal cyst and papilloma. Conclusions The inadequate, indeterminate, false-negative and false-positive cases showed similar histological types, notably SIDC for malignant tumors, and mastopathy, fibroadenoma and papilloma for benign cases. We need to pay particular attention to the collection and assessment of aspirates for these histological types of breast disease. In particular, several inadequate, indeterminate and false-negative cases with samples collected by aspiration were diagnosed as SIDC. These findings should encourage the use of needle biopsy rather than aspiration when this histological type is identified on imaging. Namely, good communication between clinicians and pathological staff, and triple assessment (i.e., clinical, pathological and radiological assessment), are important for accurate diagnosis of aspiration samples. Virtual slides The virtual slide(s) for this article can be found here:
http://www.diagnosticpathology.diagnomx.eu/vs/7349809170055423
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Affiliation(s)
- Rin Yamaguchi
- Department of Pathology, Kurume University Medical Center, Kurume, Japan.
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Ward S, Jewkes A, Jones B, Chaudhri S, Hejmadi R, Ismail T, Hallissey M. The sensitivity of needle core biopsy in combination with other investigations for the diagnosis of phyllodes tumours of the breast. Int J Surg 2012; 10:527-31. [DOI: 10.1016/j.ijsu.2012.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 08/02/2012] [Accepted: 08/06/2012] [Indexed: 10/28/2022]
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31
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Yamaguchi R, Tsuchiya SI, Koshikawa T, Yokoyama T, Mibuchi K, Nonaka Y, Ito S, Higuchi H, Nagao M, Watanabe J, Higaki K, Kage M, Yano H. Comparison of the accuracy of breast cytological diagnosis at seven institutions in southern Fukuoka Prefecture, Japan. Jpn J Clin Oncol 2011; 42:21-8. [PMID: 22107786 DOI: 10.1093/jjco/hyr165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Cytological examination is inexpensive and relatively simple to carry out and deserves utilization in breast cancer screening. We investigated the status of cytological diagnosis at seven facilities in southern Fukuoka Prefecture, Japan. METHODS We collected data on the criteria for cytological judgments and status of breast cytological diagnosis at seven different facilities in this region. RESULTS Among 5693 individuals who underwent breast cytological examination, analyses were conducted on 1250 individuals (22.0%) in whom cytological diagnoses were confirmed by histological diagnoses. Among these patients, cytological diagnosis had an absolute sensitivity of 71.9%, a specificity of 76.0%, a false-negative value of 6.7% and a false-positive value of 0.08%. At three facilities with relatively large numbers of cases (>300), excluding a facility for specialized breast disease, similar trends of high complete sensitivity (94.3, 95.6 and 97.1%, respectively) and low absolute sensitivity (60.4, 74.8 and 57.2%, respectively) were found. No false-negative or false-positive cases were seen in individual facilities with relatively low numbers of cases (<150). CONCLUSIONS The accuracy of cytological diagnosis at the facilities we surveyed was relatively high compared with the goals of assessment of diagnostic accuracy. However, the performance was dependent on the facility type, i.e. number of cases, staff involved and whether it was specialized or not, making the diagnosis specific for this region. We recommend that management of the accuracy of cytological diagnosis be undertaken jointly by multiple facilities to establish systems in Japan that lead to more useful diagnostic tools.
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Affiliation(s)
- Rin Yamaguchi
- Department of Pathology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
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Lacambra MD, Lam CC, Mendoza P, Chan SK, Yu AM, Tsang JYS, Tan PH, Tse GM. Biopsy sampling of breast lesions: comparison of core needle- and vacuum-assisted breast biopsies. Breast Cancer Res Treat 2011; 132:917-23. [PMID: 21698409 DOI: 10.1007/s10549-011-1639-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 06/10/2011] [Indexed: 10/18/2022]
Abstract
Needle biopsy is now the initial investigation of choice for the pre-operative diagnosis of breast lesions. This includes core needle biopsy (CNB) and vacuum-assisted biopsy (VAB) with or without radiologic assistance. The performance indices of both of these biopsy techniques were evaluated. In a large cohort of patients with breast lesions including 464 cases (285 CNB and 179 VAB), with confirmed outcomes, the diagnostic accuracy was compared using parameters including quantitation of the sampling based on the total number of cores taken, cores containing breast parenchyma, and cores with lesion; and non-epithelial changes including necrosis and calcification. CNB showed a 99% PPV, 94% NPV, 96% sensitivity, and 99% specificity, whereas VAB demonstrated a 100% PPV, 100% NPV, 100% sensitivity, and 100% specificity. The correct diagnosis in CNB was proportional to the number of cores extracted, whereas accuracy of VAB was independent of the total number of cores taken. There was a positive correlation between the presence of calcification and malignancy in CNB, but not detected under VAB. CNB and VAB were equally efficient in palpable lesions, in detecting necrosis, and calcification. Large calcification was found to be associated with malignancy in both CNB and VAB. In non-palpable lesions, VAB was more effective in the detection of calcification. The diagnostic accuracy of VAB appeared to be independent of number of cores sampled, whereas CNB required a minimum of 3-4 cores to achieve high diagnostic accuracy.
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Affiliation(s)
- Maribel D Lacambra
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, Shatin, Hong Kong, People's Republic of China
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Mendoza P, Lacambra M, Tan PH, Tse GM. Fine needle aspiration cytology of the breast: the nonmalignant categories. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:547580. [PMID: 21660275 PMCID: PMC3108472 DOI: 10.4061/2011/547580] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/21/2011] [Accepted: 03/21/2011] [Indexed: 11/24/2022]
Abstract
Currently, accurate diagnosis of breast lesions depends on a triple assessment approach comprising clinical, imaging and pathologic examinations. Fine needle aspiration cytology (FNAC) is widely adopted for the pathologic assessment because of its accurracy and ease of use. While much has been written about the atypical and maliganant categories of FNAC diagnosis, little covers the non-malignanat category which represents a sheer number in all FNAC cases. Moreover, any false-negative diagnosis of the non-malignant cases may lead to missed diagnosis of cancer. This paper aims to discuss the issues of smear adequacy, the cytologic features of benign breast lesions and the dilemma of a false-negative aspirate. Much has been suggested about the smear adequacy criterion, including quantifying epithelial clusters, whereas others advocate basing adequacy on qualitative quantum of using noncellular features of FNAC. Various benign lesions could be easily diagnosed at FNAC; however, they have cytologic features overlapped with malignant lesions. False negativity of FNAC does occur; this could be caused by either “true” false-negative cases attributed to suboptimal sampling technique, poor localization of the mass or nonpalpable lesions or “false” false-negative cases due to interpretational errors. Though false-positive cases are less commonly found, they will also be discussed briefly.
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Affiliation(s)
- Paulo Mendoza
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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