Use of radiology for the pathologist in the management of breast lesions

In-laboratory breast specimen radiography reduces tissue block utilization and improves turnaround time of pathologic examination

Background

This study was performed to determine whether in-laboratory specimen radiography reduces turnaround time or block utilization in surgical pathology.

Methods

Specimens processed during a 48-day trial of an in-lab cabinet radiography device (Faxitron) were compared to a control group of specimens imaged in the mammography suite during a prior 1-year period, and to a second group of specimens not undergoing imaging of any type.

Results

Cases imaged in the mammography suite had longer turnaround time than cases not requiring imaging (by 1.15 days for core biopsies, and 1.73 days for mastectomies; p < 0.0001). In contrast, cases imaged in-lab had turnaround time that was no longer than unimaged cases (p > 0.05 for core biopsies, lumpectomies and mastectomies). Mastectomies imaged in-lab required submission of fewer blocks than controls not undergoing any imaging (mean reduction of 10.6 blocks).

Conclusions

Availability of in-lab radiography resulted in clinically meaningful improvements in turnaround time and economically meaningful reductions in block utilization.

An active pixel sensor x-ray diffraction (APXRD) system for breast cancer diagnosis

This paper describes the potential application of an active pixel sensor-based x-ray diffraction (APXRD) system in the field of breast cancer diagnosis. The design and initial testing of the system was reported previously (Bohndiek et al 2008b Phys. Med. Biol. 53 655-72). The system has potential both as a 'diffraction enhanced breast imager' (DEBI) and as a probe for quantitative analysis of breast biopsy samples. The resolution of the system in a DEBI arrangement is 1 mm and the contrast available using a material-specific x-ray diffraction image was found to be up to seven times greater than that of a transmission image. Scatter signatures from a series of biopsy-equivalent samples, ranging in composition from 100% fat to 100% fibrous tissue, were acquired with the APXRD system. Multivariate data analysis was used to produce a partial least squares (PLS) model sensitive to sample fat content. The final model is able to accurately predict the fat content of a series of unknown samples and is robust to significant added noise. This suggests that the APXRD system could provide a simple, semi-automated, quantitative measurement system for analysis of breast biopsy samples. Training on a range of scatter signatures from real breast biopsy samples covering various stages of disease is now needed to test this hypothesis.

Mastectomies after vacuum core biopsy procedure for microcalcification clusters: value of clip

PURPOSE

The study was performed to substantiate the value of detecting clips in mastectomy specimens as a guide to taking pathological samples.

MATERIAL AND METHODS

We performed a retrospective review of 4 cases of mastectomy required after biopsies of microcalcifications. In each case a metallic clip had been inserted at the end of the vacuum core biopsy procedure.

RESULTS

The study included 7 microcalcification clusters with a mean size of 6.7mm corresponding to multifocal or relapsing ductal carcinoma in situ. Gross examination of the mastectomy specimens revealed no evidence of tumoral lesions or fibrous scar tissue. Radiographic examination of the serial slices did not detect any microcalcifications, but confirmed the presence of the clip in the 7 clusters in 4 cases. Histological examination was performed on the areas identified by the clips and detected scar tissue indicating the location of the biopsies and tumoral lesions in all the specimens.

CONCLUSION

In the pathological management of mastectomy specimens following vacuum core biopsies, gross examination may reveal no abnormalities and slice radiography may fail to detect microcalcifications. In such cases, radiography of the serial slices allows localisation of the metallic clips inserted during the vacuum-assisted biopsy procedure and remains the only way for the pathologist to select mastectomy specimens for microscopic analysis.

Why current breast pathology practices must be evaluated. A Susan G. Komen for the Cure white paper: June 2006

Ending breast cancer has long been the mission of Susan G. Komen for the Cure. To this end, the organization has a strong interest and proven track record in ensuring public investment in quality breast health and breast cancer care. Recently, Susan G. Komen for the Cure identified major issues in the practice of pathology that have a negative impact on the lives of thousands of breast cancer patients in the United States. These issues were identified through a comprehensive literature review and interviews conducted in 2005-2006 with experts in oncology, breast pathology, surgery, and radiology. The interviewees practiced in community, academic, and cooperative group settings. Komen for the Cure has identified four areas that have a direct impact on the quality of care breast cancer patients receive in the United States, the accuracy of breast pathology diagnostics, the effects of current health insurance, and reimbursement policies on patients who are evaluated for a possible breast cancer diagnosis, the substantial decrease in tissue banking participation, particularly during a time of rapid advances in biologically correlated clinical science and the role for the Susan G. Komen for the Cure, pathology professional societies and the Federal government in ensuring that breast pathology practices meet the highest possible standards in the United States Concerns surrounding the quality and practice of breast pathology are not limited to diagnostic accuracy. Other considerations include, training and proficiency of pathologists who are evaluating breast specimens, the lack of integration of pathologists in the clinical care team, inadequate compensation for the amount of work required to thoroughly analyze specimens, potential loss in translational research as a result of medical privacy regulations, and the lack of mandatory uniform pathology practice standards without any way to measure the degree of variation or to remedy it.