Diagnostic value of fine needle aspiration and core needle biopsy in special types of breast cancer

Electrical lymph node scanning (ELS) system for real-time intra-operative detection of involved axillary lymph nodes in adjuvant breast cancer patients

Lymph node (LN) status is an essential prognostic factor in breast cancer (BC) patients, with an important role in the surgical and therapeutic plan. Recently, we have been developed a novel system for real-time intra-operative electrical LN scanning in BC patients. The ELS scores were calibrated by pathological evaluation of the LNs. Herein, we evaluated the efficacy of ELS in a prospective study for non-chemo-treated breast cancer patients. This is a prospective study in which ELS scores are blind for pathologists who declare the clearance or involvement of LNs based on permanent pathology as the gold standard. ELS and frozen-section (FS) pathology results were achieved intra-operatively, and samples were sent for the permanent pathology. The score of ELS did not affect the surgeons' decision, and the treatment approach was carried out based on FS pathology and pre-surgical data, such as imaging and probable biopsies. Patients were recruited from October 2021 through November 2022, and 381 lymph nodes of 97 patients were included in the study. In this study we recruited 38 patients (39.2%) with sentinel lymph node biopsy (SLNB) and 59 patients (60.8%) with ALND. Of the 381 LNs scored by ELS, 329 sentinel LNs underwent routine pathology, while others (n = 52) underwent both FS and permanent pathology. ELS showed a sensitivity of 91.4% for node-positive patients, decreasing to 84.8% when considering all LNs. Using ROC analysis, ELS diagnosis showed a significant AUC of 0.878 in relation to the permanent pathology gold standard. Comparison of ELS diagnosis for different tumor types and LN sizes demonstrated no significant differences, while increasing LN size correlated with enhanced ELS sensitivity. This study confirmed ELS's efficacy in real-time lymph node detection among non-chemo-treated breast cancer patients. The use of ELS's pathological scoring for intra-operative LN diagnosis, especially in the absence of FS pathology or for non-sentinel LN involvement, could improve prognosis and reduce complications by minimizing unnecessary dissection.

The Effect of Using Virtual Reality During Breast Biopsy on Pain and Anxiety: A Randomized Controlled Trial

PURPOSE

Virtual reality (VR) is a nonpharmacological method used in healthcare settings. This study aimed to determine the effectiveness of distraction through VR on pain and anxiety during fine needle aspiration (FNA) breast biopsy.

DESIGN

This was a randomized controlled trial.

METHODS

A total of 60 Turkish females undergoing FNA breast biopsies were randomly divided into two groups. The patients in the experimental group (n = 30) viewed a specific scenario using VR from one minute before the procedure to the end of the procedure. The patients in the control group (n = 30) were subject to a standard protocol in which no anesthetic was given during the procedure. Immediately after the implementation of the FNA breast biopsy, the pain scores of all patients in groups were measured with the Visual Analogue Scale (VAS), and their anxiety levels were assessed with the State-Trait Anxiety Inventory.

FINDINGS

A statistically significant difference was determined between the post-procedure mean pain scores and average state anxiety scores of the patients in the experimental and control groups (P < .001).

CONCLUSIONS

The use of VR during FNA breast biopsy is effective in reducing pain and anxiety in adult female patients.

Predictive Role of Biopsy Based Biomarkers for Radiotherapy Treatment in Rectal Cancer

Background and Purpose: Radiation therapy has long been contemplated as an important mode in the treatment of rectal cancer. However, there are few ideal tools available for clinicians to make a radiotherapy decision at the time of diagnosis for rectal cancer. The purpose of this study was to assess whether biomarkers expressed in the biopsy could help to choose the suitable therapy and provide predictive and/or prognostic information. Experimental Design: In total, 30 biomarkers were analyzed in 219 biopsy samples before treatment to discover the possibility of using them as an indicator for radiotherapy selection, diagnosis, survival and recurrence. Results: Twenty-two biomarkers (COX2-RT, COX2-NonRT, etc.; 36.67%) had diagnostic value. For survival, four biomarkers (NFKBP65, p130, PINCH and PPAR) were significant in regulating gene promoter activity and overall survival, while four had a trend (AEG1, LOX, SATB1 and SIRT6). Three biomarkers (COX2, PINCH and WRAP53) correlated with disease-free survival, while eight had a trend (AEG1, COX2, Ki67, LOX, NFKBP65, PPAR and SATB1). Four biomarkers (COX2-RT, NFKBP65cyto-RT, P130cyto-NonRT and PPARcyto-RT) were independent prognostic factors for recurrence. NFKBP65 and SIRT6 were significantly correlated with lymph node metastasis regardless of radiation. Patients with high AEG1, LOX, NFKBP65, PPAR and SATB1 had or showed a positive trend for better survival after radiotherapy, while those with positive PINCH and WRAP53 expression would not benefit from radiotherapy. Conclusions: AEG1, LOX, NFKBP65cyto, PPAR and SATB1 could be used as indicators for choosing radiotherapy. COX2-RT, COX2-NonRT and some other biomarkers may provide additional help for diagnosis.

Electrically guided interventional radiology, in-vivo electrochemical tracing of suspicious lesions to breast cancer prior to core needle biopsy

An electrochemical biopsy probe was designed and fabricated to detect cancer tumors under the sonography guide without the need for any sample dissection (biopsy). The system was based on recording the hypoxic function of cancer tumors by Multi-wall carbon nanotubes (MWCNTs) sensing agents had been decorated on the tip of the needle electrodes by an electrostatic deposition method. This system named BGP successfully distinct 4T1 and MC4L2 breast tumors from normal lesions. It also diagnosed the treated tumors from vital ones. BGP as a clinically useful biosensor would detect the cancerous probability of any suspicious breast mass without any sample excision. Also, it can present a profile from neoplastic states of different regions of a tumor. This ability would make ensure for the radiologist to do biopsy or not, especially in the cases which are suspicious between BIRADS III and IVa. This would not only shed new light in detecting breast cancer tumors without biopsy (applied in radiological BIRADS classifications) but also evaluate the therapeutic effects on cancer tumors after chemotherapy/radiotherapy therapies without complicated and expensive scanning.

Pleomorphic lobular carcinoma of the breast: a comparison of cytopathological features with other lobular carcinoma variants

OBJECTIVE

Pleomorphic lobular carcinoma (PLC) is a subtype of breast cancer with unique morphological features, but it remains controversial whether PLC should be considered an independent disease entity. The aim of this study was to illustrate cytopathological characteristics of PLC in comparison with other lobular carcinoma variants.

METHODS

We investigated clinicopathological features of PLC (n = 11) compared with those of other variants of invasive lobular carcinoma (ILC, non-PLC) (n = 32). Histological variants of the non-PLC group consisted of classic (n = 25), solid (n = 2), alveolar (n = 1) and a tubulolobular type (n = 4). A review of cytological reports and fine needle aspiration (FNA) smear samples was performed for the PLC (n = 9) and non-PLC (n = 27) groups.

RESULTS

Patients with PLC were older, and had a higher nuclear grade and a higher incidence of axillary lymph node metastasis and triple negative phenotype than non-PLC patients (P = 0.007, P < 0.001, P = 0.02 and P < 0.001, respectively). Cytological findings in PLC included medium- to large-sized nuclei, prominent nucleoli, a moderate-to-severe degree of pleomorphism, apocrine change and background necrosis, none of which were evident in the smears of the non-PLC group (P < 0.001, P = 0.002, P < 0.001, P < 0.001, and P = 0.03, respectively). Despite these differences, patients with PLC and non-PLC showed similar clinical outcomes in our follow-up period.

CONCLUSIONS

Based on our results, a cytological diagnosis of PLC should be proposed if there are moderate- to large-sized nuclei, prominent nucleoli, a moderate-to severe degree of nuclear pleomorphism, apocrine change and necrosis in the background in FNA biopsy samples.