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Suciu V, El Chamieh C, Soufan R, Mathieu MC, Balleyguier C, Delaloge S, Balogh Z, Scoazec JY, Chevret S, Vielh P. Real-World Diagnostic Accuracy of the On-Site Cytopathology Advance Report (OSCAR) Procedure Performed in a Multidisciplinary One-Stop Breast Clinic. Cancers (Basel) 2023; 15:4967. [PMID: 37894334 PMCID: PMC10605571 DOI: 10.3390/cancers15204967] [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: 07/09/2023] [Revised: 08/19/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023] Open
Abstract
Fine-needle aspiration (FNA) cytology has been widely used for the diagnosis of breast cancer lesions with the objective of differentiating benign from malignant masses. However, the occurrence of unsatisfactory samples and false-negative rates remains a matter of concern. Major improvements have been made thanks to the implementation of rapid on-site evaluation (ROSE) in multidisciplinary and integrated medical settings such as one-stop clinics (OSCs). In these settings, clinical and radiological examinations are combined with a morphological study performed by interventional pathologists. The aim of our study was to assess the diagnostic accuracy of the on-site cytopathology advance report (OSCAR) procedure on breast FNA cytologic samples in our breast OSC during the first three years (April 2004 till March 2007) of its implementation. To this goal, we retrospectively analyzed a series of 1820 breast masses (1740 patients) radiologically classified according to the American College of Radiology (ACR) BI-RADS lexicon (67.6% being either BI-RADS 4 or 5), sampled by FNA and immediately diagnosed by cytomorphology. The clinicoradiological, cytomorphological, and histological characteristics of all consecutive patients were retrieved from the hospital computerized medical records prospectively registered in the central information system. Histopathological analysis and ultrasound (US) follow-up (FU) were the reference diagnostic tests of the study design. In brief, we carried out either a histopathological verification or an 18-month US evaluation when a benign cytology was concordant with the components of the triple test. Overall, histology was available for 1138 masses, whereas 491 masses were analyzed at the 18-month US-FU. FNA specimens were morphologically nondiagnostic in 3.1%, false negatives were observed in 1.5%, and there was only one false positive (0.06%). The breast cancer prevalence was 62%. Diagnostic accuracy measures of the OSCAR procedure with their 95% confidence intervals (95% CI) were the following: sensitivity (Se) = 97.4% (96.19-98.31); specificity (Sp) = 94.98% (92.94-96.56); positive predictive value (PPV) = 96.80% (95.48-97.81); negative predictive value (NPV) = 95.91% (94.02-97.33); positive likelihood ratio (LR+) = 19.39 (13.75-27.32); negative predictive ratio (LR-) = 0.03 (0.02-0.04), and; accuracy = 96.45% (95.42-97.31). The respective positive likelihood ratio (LR+) for each of the four categories of cytopathological diagnoses (with their 95% CI) which are malignant, suspicious, benign, and nondiagnostic were 540 (76-3827); 2.69 (1.8-3.96); 0.03 (0.02-0.04); and 0.37 (0.2-0.66), respectively. In conclusion, our study demonstrates that the OSCAR procedure is a highly reliable diagnostic approach and a perfect test to select patients requiring core-needle biopsy (CNB) when performed by interventional cytopathologists in a multidisciplinary and integrated OSC setting. Besides drastically limiting the rate of nondiagnostic specimens and diagnostic turn-around time, OSCAR is an efficient and powerful first-line diagnostic approach for patient-centered care.
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Affiliation(s)
- Voichita Suciu
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Carolla El Chamieh
- Department of Biostatistics and Medical Information, INSERM UMR1153 ECSTRRA Team, Hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - Ranya Soufan
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | | | | | - Suzette Delaloge
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Zsofia Balogh
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | | | - Sylvie Chevret
- Department of Biostatistics and Medical Information, INSERM UMR1153 ECSTRRA Team, Hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - Philippe Vielh
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
- Medipath and American Hospital of Paris, 92200 Paris, France
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Biomarker Discordances and Alterations Observed in Breast Cancer Treated with Neoadjuvant Chemotherapy: Causes, Frequencies, and Clinical Significances. Curr Oncol 2022; 29:9695-9710. [PMID: 36547175 PMCID: PMC9776827 DOI: 10.3390/curroncol29120761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Biomarker discordances and alterations can be encountered between tru-cut biopsy and residual tumor in breast cancer treated with neoadjuvant chemotherapy (NACTx). We aimed to investigate the effect of NACTx on major biomarker expression (ER, PR, HER2, Ki-67) and tumor grade, the frequency and causes of receptor discordances, and the clinical significance of changes in terms of adjuvant therapy need and chemosensitivity. METHODS In this retrospective study, ER, PR, HER2, and Ki-67 expression and tumor grades were compared between pre- and post-NACTx tumor samples using the Wilcoxon signed-rank test. The frequencies of receptor discordances and the need for new adjuvant therapy due to discordances were calculated. The effect of patient and tumor characteristics and NACTx regimens on discordances was investigated using multivariate analysis. Using histopathological examinations, residual tumors were divided into chemotherapy-responsive and chemotherapy-unresponsive tumors. Biomarker changes in both groups were analyzed for predictability of chemosensitivity. RESULTS Of the 169 patients who received NACTx, 102 patients having enough residual tumors in the surgical pathology specimen were enrolled in the study. Histopathologically, about 70% of tumors were partially responsive to NACTx and 30% were unresponsive (chemo-resistant). The concordance and discordance rates were 95.1% versus 4.9% for ER (p = 0.180), 97.1% versus 2.9% for PR (p = 0.083), and 89.2% versus 10.8% for HER2 (p = 0.763), respectively. In addition, 15% of hormone receptor (HR)-negative patients became HR(+) and 5.7% of HER2(-) patients became HER2(+) in the residual tumors, requiring adjuvant endocrine or anti-HER2 therapy. In particular, 18% of triple-negative patients became HR(+) and 12% became HER2(+). HER2 loss was detected in 40% of HER2(+) patients. Multivariate logistic regression analysis revealed that lower estrogen expression (p = 0.046), a smaller tumor size (p = 0.029), and anti-HER2 therapy (p < 0.001) have independent efficacy on ER discordance, PR discordance, and HER2 discordance, respectively. Ki-67 and PR expression significantly decreased in chemotherapy-responsive tumors (p = 0.001 and p = 0.004), and the tumor grade increased in chemotherapy-unresponsive tumors (p = 0.034). CONCLUSIONS Approximately 3-5% of HR discordance and about 10% of HER2 discordance can be observed in breast cancer after currently used NACTx regimens. Discordances are bi-directional (from positive to negative and vice versa), and their causes are multifactorial; they should be assessed accordingly. The NACTx effect alone cannot explain observed discordances but can cause biomarker alterations. The change in receptor status from positive to negative, especially HER2 loss, is mainly associated with the NACTx effect. However, the shift from negative to positive is thought to be primarily related to intratumoral heterogeneity. Receptor statuses becoming positive are of more clinical importance due to adjuvant therapy requirements. Biomarker alterations in PR, Ki-67, and tumor grade can provide predictive information about tumor chemosensitivity.
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Garduño-Alanis A, Morales-González L, Ángeles-Llerenas A, Delgado-Ramírez JZ, Ortega-Olvera C, Torres-Mejía G. The effect of the number of biopsies on the delay in the time from the delivery of mammography results to breast cancer histopathological diagnosis. Cancer Causes Control 2022; 33:1355-1361. [PMID: 36029415 DOI: 10.1007/s10552-022-01622-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The delay in the time (in calendar days) from the delivery of mammography results to histopathological breast cancer (BC) diagnosis could be associated with more advanced clinical stages, a worse prognosis and higher mortality. Therefore, we assessed the association between the number of biopsies and the delay in the time (in calendar days) from the delivery of mammography results to histopathological BC. METHODS A survey was performed on 563 women aged between 35 and 69 years with histopathologically confirmed BC who attended 11 Mexican hospitals. RESULTS After adjusting for potential confounders, the odds of having a delay in the time (in calendar days) from the delivery of mammography results to histopathological BC diagnosis (≥ 60 days) among women with ≥ 3 biopsies were 2.99 times the odds of those who had only one biopsy (95% CI 1.35, 6.63). CONCLUSION The number of biopsies should be considered as a predictor of the time delay between the delivery of the mammography result and the diagnostic result.
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Affiliation(s)
- Adriana Garduño-Alanis
- School of Nursing and Obstetrics, Autonomous University of the State of Mexico, Paseo Tollocan s/n, Esquina Jesús Carranza, Col. Moderna de la Cruz, C.P. 50180, Toluca, MEX., Mexico
| | - Lizbeth Morales-González
- Research Department, Universidad de la Salud del Estado de México, Vialidad Toluca Atlacomulco 1946, Col. La Aviación, C.P. 50295, Toluca, MEX., Mexico
| | - Angélica Ángeles-Llerenas
- Center for Population Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - José Zaim Delgado-Ramírez
- Center for Population Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Carolina Ortega-Olvera
- School of Nursing and Nutrition, Autonomous University of San Luis Potosi, Av. Niño Artillero #130, Zona Universitaria, C.P. 78240, San Luis Potosí, Mexico
| | - Gabriela Torres-Mejía
- Center for Population Health Research, Instituto Nacional de Salud Pública, Mexico City, Mexico.
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Krarup Sigaard R, Wennervaldt K, Munksgaard L, Rahbek Gjerdrum LM, Homøe P. Core needle biopsy is an inferior tool for diagnosing cervical lymphoma compared to lymph node excision. Acta Oncol 2021; 60:904-910. [PMID: 34003078 DOI: 10.1080/0284186x.2021.1916999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In Denmark, fine needle aspiration is the standardized tool for obtaining tissue samples from lymph nodes (LN) of the neck. However, because of a low specificity toward lymphomas, LNs suspicious for this disease are often surgically removed and examined. International studies have implied that a core needle biopsy (CNB) is sufficient for detecting lymphomas, thereby potentially avoiding surgery. However, all studies have been conducted retrospectively and the goal of this prospective study was to find the true sensitivity of CNB. MATERIAL AND METHODS Fifty-seven patients were enrolled in the study, one was excluded due to lack of CNB material. LNs suspected for lymphoma were surgically removed from the neck, whereafter a CNB was obtained from the removed LN. The CNB and the remaining part of the LN were sent to the Department of Pathology for further processing and the samples were blinded and examined by two pathologists separately. A consensus diagnosis was reached in cases with divergent diagnostic proposals. Sensitivity of the CNB method in comparison to whole tissue sections for lymphoma diagnosis was calculated. RESULTS The CNB method gave the correct diagnosis in 66% of lymphoma cases, was inconclusive in 14% and gave an incorrect lymphoma subtype in 18%. In 2% the CNB wrongly resulted in a benign diagnosis. CNB was correct in all the non-lymphoma cases; thereby retaining a specificity of 100%. CONCLUSION This prospective study found a sensitivity of 66% for diagnosing lymphoma with a CNB. As the CNB in this study was obtained under optimal conditions, unlike in clinical practice, we conclude that CNB cannot be recommended as a standard tool for diagnosing lymphomas.
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Affiliation(s)
- Rasmus Krarup Sigaard
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Kasper Wennervaldt
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Lars Munksgaard
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Lise Mette Rahbek Gjerdrum
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Verma P, Sharma R, Sharma N, Gulati A, Parashar A, Kaundal A. Fine-Needle Aspiration Cytology versus Core-Needle Biopsy for Breast Lesions: A Dilemma of Superiority between the Two. Acta Cytol 2021; 65:411-416. [PMID: 34192704 DOI: 10.1159/000517005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/03/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Core-needle biopsy (CNB) is a minimally invasive procedure used in preoperative diagnosis of breast lumps. It has been seen that in few years, the CNB seems to be replacing the fine-needle aspiration cytology (FNAC), although no study had yet conclusively proved a superiority of one over the other. AIMS AND OBJECTIVES The aim of this study was to study the cytohistological spectrum of palpable breast lesions and to evaluate the diagnostic accuracy of FNAC versus CNB for breast lesions. MATERIALS AND METHODS The study was a cross-sectional study conducted in the Department of Pathology and Surgery, over a period of 1 year in 152 patients. All the patients were subjected to FNAC and CNB. Cytosmears were stained with May-Grunwald Giemsa and hematoxylin and eosin was done on CNB and excision biopsy (EB) specimens. Sensitivity and specificity were calculated in percentage with 95% confidence interval with reference to CNB/surgical specimens. Kappa statistics were used to compare the level of agreement between FNAC versus CNB and CNB versus surgical specimens. RESULTS A total of 152 patients were taken for FNAC and CNB. EB was performed in only 104 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FNAC verses CNB in correlation with subsequent histopathology were found to be (93.40 vs. 94.06%), (97.50 vs. 100.00%), (99.00 vs. 100.00%), (84.78 vs. 33.33%), and (94.52 vs. 94.23%), respectively. CONCLUSION CNB has overcome the pitfall of FNAC but CNB cannot replace FNAC but both procedures are complementary to each other.
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Pritzker KPH, Nieminen HJ. Needle Biopsy Adequacy in the Era of Precision Medicine and Value-Based Health Care. Arch Pathol Lab Med 2019; 143:1399-1415. [PMID: 31100015 DOI: 10.5858/arpa.2018-0463-ra] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT.— Needle biopsy of diseased tissue is an essential diagnostic tool that is becoming even more important as precision medicine develops. However, the capability of this modality to efficiently provide samples adequate for diagnostic and prognostic analysis remains quite limited relative to current diagnostic needs. For physicians and patients, inadequate biopsy frequently leads to diagnostic delay, procedure duplication, or insufficient information about tumor biology leading to delay in treatment; for health systems, this results in substantial incremental costs and inefficient use of scarce specialized diagnostic resources. OBJECTIVE.— To review current needle biopsy technology, devices, and practice with a perspective to identify current limitations and opportunities for improvement in the context of advancing precision medicine. DATA SOURCES.— PubMed searches of fine-needle aspiration and core needle biopsy devices and similar technologies were made generally, by tissue site, and by adequacy as well as by health economics of these technologies. CONCLUSIONS.— Needle biopsy adequacy can be improved by recognizing the importance of this diagnostic tool by promoting common criteria for needle biopsy adequacy; by optimizing needle biopsy procedural technique, technologies, clinical practice, professional education, and quality assurance; and by bundling biopsy procedure costs with downstream diagnostic modalities to provide better accountability and incentives to improve the diagnostic process.
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Affiliation(s)
- Kenneth P H Pritzker
- From the Departments of Laboratory Medicine and Pathobiology, and Surgery, University of Toronto, Toronto, Ontario, Canada (Dr Pritzker); and the Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland (Dr Nieminen)
| | - Heikki J Nieminen
- From the Departments of Laboratory Medicine and Pathobiology, and Surgery, University of Toronto, Toronto, Ontario, Canada (Dr Pritzker); and the Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland (Dr Nieminen)
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Carrilho C, Ismail M, Lorenzoni C, Fernandes F, Alberto M, Akrami K, Funzamo C, Lunet N, Schmitt F. Fine needle aspiration cytology in Mozambique: Report of a 15-year experience. Diagn Cytopathol 2018; 47:166-171. [PMID: 30478961 DOI: 10.1002/dc.24062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/25/2018] [Accepted: 08/03/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fine needle aspiration cytology (FNAC) is an important diagnostic tool in a range of medical settings. It is fast, quick and a highly accurate diagnostic method and can be used, in settings with minimal laboratory infrastructures. METHODS In this report, we describe the experience in the use of FNAC since it is introduction in 1996 in the Anatomical Pathology Service of the Maputo Central Hospital (MCH), along with more detailed data referring to 2009-2010. RESULTS The number of FNAC analyses increased gradually from 269 (4.1% of all pathologic tests of the Service) in 1996, when it was introduced in Mozambique, to 3234 (17% of all tests) in 2010. Lymph nodes were the organs most frequently biopsied, followed by breast and soft tissues. Inflammatory conditions, especially tuberculosis, were the most frequent diagnoses (22.2% of the cases), followed by hyperplastic conditions (20.6%), benign tumors (13.4%) and malignant tumors (12.3%). CONCLUSION Our results clearly demonstrate that even in an environment with poor laboratory resources, it is possible to establish a FNAC clinic that can provide a quick and precise diagnosis for clinicians to aid in early treatment interventions, especially in inflammatory diseases which were the majority of our cases.
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Affiliation(s)
- Carla Carrilho
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Mamudo Ismail
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Cesaltina Lorenzoni
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique.,National Cancer Control Program Ministry of Health, Maputo, Mozambique
| | - Fabíola Fernandes
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Matos Alberto
- Departamento de Patologia, Hospital Central de Maputo, Maputo, Moçambique
| | - Kevan Akrami
- Department of Infectious Disease, University of California, San Diego, San Diego, California
| | - Carlos Funzamo
- National Cancer Control Program Ministry of Health, Maputo, Mozambique
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Fernando Schmitt
- Instituto de Patologia e Imunologia Molecular da Universidade do Porto, IPATIMUP, Porto, Portugal.,Departamento de Patologia da Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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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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Kombak FE, Şahin H, Mollamemişoğlu H, Önem İ, Kaya H, Buğdaycı O, Arıbal E. Concordance of immunohistochemistry between core needle biopsy and surgical resection of breast cancer. Turk J Med Sci 2017; 47:1791-1796. [PMID: 29306240 DOI: 10.3906/sag-1702-152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: The purpose of this study was to evaluate the concordance of immunohistochemical (IHC) parameters of breast lesions between the core needle biopsy (CNB) and the surgical resection specimen. Materials and methods: CNB and resection specimens of female patients were retrospectively analyzed. ER, PR, HER-2, and Ki-67 parameters were compared for each patient. A total of 284 cases were assessed. Forty-one and 48 cases were excluded from the HER-2 and Ki-67 examinations, respectively, because the CNBs did not allow for IHC. Results: Concordance rates were 93.3% for ER, 89.4% for PR, 90.1% for HER-2, and 80.9% for Ki-67.Conclusion: CNB is accurate for the evaluation of the surrogate molecular profile of invasive breast cancer despite the heterogeneity of tumors.
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10
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Bicchierai G, Rigacci L, Miele V, Meattini I, De Benedetto D, Selvi V, Bianchi S, Livi L, Nori J. Role of core needle biopsy in primary breast lymphoma. Radiol Med 2017; 122:651-655. [PMID: 28510806 DOI: 10.1007/s11547-017-0773-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/01/2017] [Indexed: 01/18/2023]
Abstract
Primary breast lymphoma (PBL) may mimic carcinoma clinically and also mammographic and ecographic distinction is subtle. Despite its rarity, incidence of PBLs has increased over the last four decades and continues to increase for younger women and for some subtypes, and for this reason it is increasingly important to achieve a preoperative pathological diagnosis using core needle biopsy (CNB) or fine-needle aspiration cytology (FNA). The aim of this retrospective study was to report our single-center experience in CNBs performed for histological diagnosis of PBL compared to FNA. From a total of 10,500 CNBs we found seven patients affected by PBL diagnosed at Careggi Florence University Hospital, between January 2000 and December 2016. Diffuse large B cell lymphoma (DLBCL) was the most frequent PBLs and on CNBs specimens was possible do the fluorescent in situ hybridization analysis to evaluate the presence of chromosomal translocation. CNB is an effective method for the assessment of PBLs, especially for DLBCL, in which a correct and fast classification could change the therapeutic approach and the prognosis.
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Affiliation(s)
- Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - Luigi Rigacci
- Hematology Department, Azienda Ospedaliero-Universitaria Careggi Florence, University of Florence, Florence, Italy
| | - Vittorio Miele
- Emergency Radiology, Department, Azienda Ospedaliero-Universitaria Careggi Florence, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Florence, University of Florence, Florence, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Valeria Selvi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi Florence, University of Florence, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
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Delaloge S, Bonastre J, Borget I, Garbay JR, Fontenay R, Boinon D, Saghatchian M, Mathieu MC, Mazouni C, Rivera S, Uzan C, André F, Dromain C, Boyer B, Pistilli B, Azoulay S, Rimareix F, Bayou EH, Sarfati B, Caron H, Ghouadni A, Leymarie N, Canale S, Mons M, Arfi-Rouche J, Arnedos M, Suciu V, Vielh P, Balleyguier C. The challenge of rapid diagnosis in oncology: Diagnostic accuracy and cost analysis of a large-scale one-stop breast clinic. Eur J Cancer 2016; 66:131-7. [PMID: 27569041 DOI: 10.1016/j.ejca.2016.06.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/30/2016] [Accepted: 06/25/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE Rapid diagnosis is a key issue in modern oncology, for which one-stop breast clinics are a model. We aimed to assess the diagnosis accuracy and procedure costs of a large-scale one-stop breast clinic. PATIENTS AND METHODS A total of 10,602 individuals with suspect breast lesions attended the Gustave Roussy's regional one-stop breast clinic between 2004 and 2012. The multidisciplinary clinic uses multimodal imaging together with ultrasonography-guided fine needle aspiration for masses and ultrasonography-guided and stereotactic biopsies as needed. Diagnostic accuracy was assessed by comparing one-stop diagnosis to the consolidated diagnosis obtained after surgery or biopsy or long-term monitoring. The medical cost per patient of the care pathway was assessed from patient-level data collected prospectively. RESULTS Sixty-nine percent of the patients had masses, while 31% had micro-calcifications or other non-mass lesions. In 75% of the cases (87% of masses), an exact diagnosis could be given on the same day. In the base-case analysis (i.e. considering only benign and malignant lesions at one-stop and at consolidated diagnoses), the sensitivity of the one-stop clinic was 98.4%, specificity 99.8%, positive and negative predictive values 99.7% and 99.0%. In the sensitivity analysis (reclassification of suspect, atypical and undetermined lesions), diagnostic sensitivity varied from 90.3% to 98.5% and specificity varied from 94.3% to 99.8%. The mean medical cost per patient of one-stop diagnostic procedure was €420. CONCLUSIONS One-stop breast clinic can provide timely and cost-efficient delivery of highly accurate diagnoses and serve as models of care for multiple settings, including rapid screening-linked diagnosis.
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Affiliation(s)
- Suzette Delaloge
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France.
| | - Julia Bonastre
- Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Isabelle Borget
- Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Jean-Rémi Garbay
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Rachel Fontenay
- Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Diane Boinon
- Gustave Roussy, Université Paris-Saclay, Department of Supportive Care, Villejuif, F-94805, France
| | - Mahasti Saghatchian
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Marie-Christine Mathieu
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Chafika Mazouni
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Sofia Rivera
- Gustave Roussy, Université Paris-Saclay, Department of Radiation Therapy, Villejuif, F-94805, France
| | - Catherine Uzan
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Fabrice André
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Clarisse Dromain
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Bruno Boyer
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Barbara Pistilli
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Sandy Azoulay
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Françoise Rimareix
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - El-Hadi Bayou
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Benjamin Sarfati
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Hélène Caron
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Amal Ghouadni
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Nicolas Leymarie
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Sandra Canale
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Muriel Mons
- Gustave Roussy, Université Paris-Saclay, Department of Medical Information, Villejuif, F-94805, France
| | - Julia Arfi-Rouche
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Monica Arnedos
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Voichita Suciu
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Philippe Vielh
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Corinne Balleyguier
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
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ADVANTAGE OF CORE NEEDLE BIOPSY OVER FINE NEEDLE ASPIRATION CYTOLOGY IN PALPABLE BREAST LUMPS. ACTA ACUST UNITED AC 2016. [DOI: 10.14260/jemds/2016/1085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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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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Ojala K, Meretoja TJ, Mattson J, Salminen-Peltola P, Leutola S, Berggren M, Leidenius MHK. The quality of preoperative diagnostics and surgery and their impact on delays in breast cancer treatment - A population based study. Breast 2016; 26:80-6. [PMID: 27017246 DOI: 10.1016/j.breast.2015.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/07/2015] [Accepted: 12/19/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study aims to clarify quality of breast cancer surgery in population-based setting. We aim to elucidate factors influencing waiting periods, and to evaluate the effect of hospital volume on surgical treatment policies. Special interest was given to diagnostic and surgical processes and their impact on waiting times. METHODS All 1307 patients having primary breast cancer surgery at the Helsinki and Uusimaa Hospital District during 2010 were included in this retrospective study. RESULTS Median waiting time for primary surgery was 24 days and significantly affected by additional imaging and diagnostic biopsies as well as hospital volume. Final rate of breast conserving surgery was surprisingly low, 51%, not affected by hospital volume, p = 0.781. Oncoplastic resection and immediate breast reconstruction (IBR) were performed more often in high volume units, p < 0.001. Quality of axillary surgery varied with unit size. Multiple operations, IBR and high volume unit were factors prolonging initiation of adjuvant treatment. CONCLUSION Quality of preoperative diagnostics play a crucial role in minimizing the need of repeated imaging and biopsies as well as multiple operations. Positive impact of high-volume hospitals becomes evident when analyzing procedures requiring advanced surgical techniques. High-volume hospitals achieved better quality in axillary surgery.
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Affiliation(s)
- Kaisu Ojala
- Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital and Helsinki University, P.O.Box 263, 00029 HUS, Finland.
| | - Tuomo J Meretoja
- Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital and Helsinki University, P.O.Box 263, 00029 HUS, Finland
| | - Johanna Mattson
- Department of Oncology, Helsinki University Hospital and Helsinki University, P.O. Box 180, 00029 HUS, Finland
| | | | - Suvi Leutola
- Porvoo Hospital, Department of Surgery, Sairaalantie 1, 06100, Porvoo, Finland
| | - Marianne Berggren
- Tammisaari Hospital, Department of Surgery, P.O.Box 1020, 10600, Raasepori, Finland
| | - Marjut H K Leidenius
- Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital and Helsinki University, P.O.Box 263, 00029 HUS, Finland
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Liikanen J, Leidenius M, Joensuu H, Vironen J, Heikkilä P, Meretoja T. Breast cancer prognosis and isolated tumor cell findings in axillary lymph nodes after core needle biopsy and fine needle aspiration cytology: Biopsy method and breast cancer outcome. Eur J Surg Oncol 2015; 42:64-70. [PMID: 26427542 DOI: 10.1016/j.ejso.2015.08.170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/11/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND It is unknown whether performing a core needle biopsy (CNB) to diagnose breast cancer increases the incidence of isolated tumor cells (ITC) in the axillary sentinel lymph nodes. METHODS Patients diagnosed with unilateral invasive pT1 breast cancer (≤2 cm in diameter, n = 1525) at a single center between February 2001 and August 2005 were included in this prospective observational cohort study. The patients were categorized into two groups according to the type of the preoperative breast needle biopsy performed, the CNB and the fine needle aspiration cytology (FNAC) groups, and followed up for a median of 9.5 years after breast surgery. RESULTS 868 (56.9%) patients had FNAC and 657 (43.2%) CNB. In the subset of patients with no axillary metastases (pN0, n = 1005) 70 patients had ITC, 37 (4.3%) out of the 546 patients in FNAC group and 33 (5.0%) out of the 459 patients in the CNB group (p = 0.798). The type of tumor biopsy did not influence breast cancer-specific survival (p = 0.461) or local recurrence-free survival (p = 0.814) in univariable survival analyses. Overall, survival favored the CNB group in a univariable analysis, but no difference in survival emerged in a multivariable analysis (p = 0.718). CONCLUSIONS CNB was not associated with a greater incidence of ITC in axillary lymph nodes as compared with FNAC, and did not have an adverse effect on survival outcomes in a patient population treated with modern adjuvant therapies.
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Affiliation(s)
- J Liikanen
- Helsinki University Central Hospital, Comprehensive Cancer Center, Breast Surgery Unit, P.O. Box 263, FIN-00029 HUS, Finland.
| | - M Leidenius
- Helsinki University Central Hospital, Comprehensive Cancer Center, Breast Surgery Unit, P.O. Box 263, FIN-00029 HUS, Finland.
| | - H Joensuu
- Helsinki University Central Hospital, Comprehensive Cancer Center, Department of Oncology, P.O. Box 180, FI-00029 Helsinki, Finland.
| | - J Vironen
- Helsinki University Central Hospital, Jorvi Hospital, Breast Surgery Unit, P.O. Box 800, FIN-00029 HUS, Finland.
| | - P Heikkilä
- Helsinki University Central Hospital, Department of Pathology, P.O. Box 400, FIN-00029 HUS, Finland.
| | - T Meretoja
- Helsinki University Central Hospital, Comprehensive Cancer Center, Breast Surgery Unit, P.O. Box 263, FIN-00029 HUS, Finland.
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Same-day diagnosis based on histology for women suspected of breast cancer: high diagnostic accuracy and favorable impact on the patient. PLoS One 2014; 9:e103105. [PMID: 25047134 PMCID: PMC4105497 DOI: 10.1371/journal.pone.0103105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/27/2014] [Indexed: 11/19/2022] Open
Abstract
Background Same-day diagnosis based on histology is increasingly being offered to patients suspected of breast cancer. We evaluated to which extent same-day diagnosis affected diagnostic accuracy and patients' anxiety levels during the diagnostic phase. Patients and methods All 759 women referred for same-day evaluation of suspicious breast lesions between November 2011–March 2013 were included. Diagnostic accuracy was assessed by linking all patients to the national pathology database to identify diagnostic discrepancies, in which case slides were reviewed. Patients' anxiety was measured in 127 patients by the State Trait and Anxiety Inventory on six moments during the diagnostic workup and changes over time (< = 1 week) were analyzed by mixed effect models. Results Core-needle biopsy was indicated in 374/759 patients (49.3%) and in 205/759 (27%) patients, invasive or in situ cancer was found. Final diagnosis on the same day was provided for 606/759 (79.8%) patients. Overall, 3/759 (0.4%) discordant findings were identified. Anxiety levels decreased significantly over time from 45.2 to 30.0 (P = <0.001). Anxiety levels decreased from 44.4 to 25.9 (P = <0.001) for patients with benign disease, and remained unchanged for patients diagnosed with malignancies (48.6 to 46.7, P = 0.933). Time trends in anxiety were not affected by other patient or disease characteristics like age, education level or (family) history of breast cancer. Conclusion Same-day histological diagnosis is feasible in the vast majority of patients, without impairing diagnostic accuracy. Patients' anxiety rapidly decreased in patients with a benign diagnosis and remained constant in patients with malignancy.
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Almobarak AO, Elhassan TM, Elhoweris MH, Awadalla HM, Elmadhoun WMY, Ahmed MH. Cytomorphologic Patterns of Breast Lesions in Sudanese Patients: Lessons Learned from Fine Needle Aspiration Cytology. Asian Pac J Cancer Prev 2014; 15:3411-3. [DOI: 10.7314/apjcp.2014.15.8.3411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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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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Georgieva RD, Obdeijn IM, Jager A, Hooning MJ, Tilanus-Linthorst MMA, van Deurzen CHM. Breast fine-needle aspiration cytology performance in the high-risk screening population: a study of BRCA1/BRCA2 mutation carriers. Cancer Cytopathol 2013; 121:561-7. [PMID: 23720450 DOI: 10.1002/cncy.21308] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/24/2013] [Accepted: 04/02/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND The diagnosis of breast lesions is usually confirmed by fine-needle aspiration cytology (FNAC) or histological biopsy. Although there is increasing literature regarding the advantages and limitations of both modalities, there is no literature regarding the accuracy of these modalities for diagnosing breast lesions in high-risk patients, who usually have lesions detected by screening. The objective of the current study was to evaluate diagnostic performance indices of FNAC in breast cancer susceptibility gene (BRCA) mutation carriers. METHODS BRCA1/BRCA2 mutation carriers who underwent FNAC were selected from the database of the Rotterdam Family Cancer Clinic. FNAC accuracy parameters were calculated by taking the outcome of a subsequent histological diagnosis or clinical follow-up as reference standard. RESULTS In total, 320 FNACs were obtained, and FNAC examination was followed by histological examination in 150 patients. The rate of insufficient material was 25.6%. Sensitivity was 92.3%, specificity 96.3%. The false-positive rate was 3.7%, the false-negative rate was 7.7%, and accuracy was 94.7%. A substantial proportion of patients (35%) with malignant FNAC results underwent histological biopsy upfront surgical resection. Small lesion size (≤ 1 cm) and nonpalpability of the breast lesion were associated with decreased FNAC accuracy. In 113 patients who had a benign FNAC outcome without histological follow-up, no malignancies were detected during clinical or radiologic surveillance (median follow-up 84 months). CONCLUSIONS There is a role for FNAC in diagnosing breast lesions of BRCA1/BRCA2 mutation carriers, ie, to confirm a radiological (probably) benign lesion. However, despite the high overall sensitivity of FNAC, the authors recommend histological biopsy as the preferred diagnostic method for high-risk patients who have small or nonpalpable lesions.
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Affiliation(s)
- Radka D Georgieva
- Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
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Bulte JP, Polman L, Schlooz-Vries M, Werner A, Besselink R, Sessink K, Mus R, Lardenoije S, Imhof-Tas M, Bulten J, van Engen-van Grunsven ACH, Schaafsma E, Strobbe LJA, Bult P, De Wilt JHW. One-day core needle biopsy in a breast clinic: 4 years experience. Breast Cancer Res Treat 2012; 137:609-16. [DOI: 10.1007/s10549-012-2372-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
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Lee CI, Wells CJ, Bassett LW. Cost minimization analysis of ultrasound-guided diagnostic evaluation of probably benign breast lesions. Breast J 2012. [PMID: 23186174 DOI: 10.1111/tbj.12055] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of this study was to compare direct health care costs for two competing diagnostic strategies for probably benign breast lesions detected by ultrasound in young women. We developed a decision analytic model and performed a cost minimization analysis comparing ultrasound-guided vacuum-assisted core biopsy and conservative short-term diagnostic ultrasound follow-up. Relative probabilities for diagnostic outcomes were derived from pooled analysis of the medical literature. Direct health care costs were estimated using United States national average figures from calendar year 2010. Deterministic sensitivity analyses were conducted, as well as a first-order Monte Carlo simulation to confirm cost differences between the two strategies. The conservative short-term imaging follow-up strategy ($639.55 average cost per patient) was the most economical strategy compared to immediate vacuum-assisted core biopsy ($879.55 average cost per patient). Sensitivity analyses demonstrated that the preferred strategy is most dependent on the probabilities of detecting change in appearance on follow-up ultrasound, having a benign finding on immediate core biopsy, and finding cancer on a biopsy triggered by an interval change in ultrasound appearance. The model was also sensitive to the costs of vacuum-assisted core biopsy and diagnostic ultrasound. Conservative imaging follow-up of BIRADS 3 breast masses by ultrasound is cost saving compared to immediate vacuum-assisted core biopsy, with a potential of saving more than one-third of overall costs associated with the diagnostic work-up of such lesions. Watchful waiting with short-term interval follow-up ultrasounds will spare women from unnecessary procedures and spare the United States health care system from unnecessary direct health care costs.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.
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Brancato B, Crocetti E, Bianchi S, Catarzi S, Risso GG, Bulgaresi P, Piscioli F, Scialpi M, Ciatto S, Houssami N. Accuracy of needle biopsy of breast lesions visible on ultrasound: Audit of fine needle versus core needle biopsy in 3233 consecutive samplings with ascertained outcomes. Breast 2012; 21:449-54. [DOI: 10.1016/j.breast.2011.10.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 08/25/2011] [Accepted: 10/26/2011] [Indexed: 11/28/2022] Open
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Nassar A. Core needle biopsy versus fine needle aspiration biopsy in breast--a historical perspective and opportunities in the modern era. Diagn Cytopathol 2010; 39:380-8. [PMID: 20949457 DOI: 10.1002/dc.21433] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 04/05/2010] [Indexed: 01/08/2023]
Abstract
Breast fine-needle aspiration biopsy (FNAB) by palpation is on the decline, due to its limitations in diagnostic accuracy, decreased sensitivity, and its replacement with core needle biopsy (CNB). Despite its decreasing utility, superficial fine-needle aspiration (FNA) in breast is still the main modality for evaluating metastatic lesions, recurrence, and axillary lymph node metastasis. New modalities including proteomic pattern expression and methylation profiling of breast lesions are other promising techniques that can be used as ancillary tests for refining the diagnosis of breast lesions using FNAB. Image-guided breast FNA proves to be a successful alternative with high sensitivity and specificity. In this review, the advantages, disadvantages, and inherent limitations of breast FNA and CNB, and new advanced techniques are discussed.
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Affiliation(s)
- Aziza Nassar
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55902, USA.
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Diagnosing breast lesions by fine needle aspiration cytology or core biopsy: which is better? Breast Cancer Res Treat 2010; 123:1-8. [DOI: 10.1007/s10549-010-0962-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 05/18/2010] [Indexed: 10/19/2022]
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Ward S, Shepherd J, Khalil H. Freehand versus ultrasound-guided core biopsies of the breast: reducing the burden of repeat biopsies in patients presenting to the breast clinic. Breast 2010; 19:105-8. [DOI: 10.1016/j.breast.2009.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 12/01/2009] [Accepted: 12/05/2009] [Indexed: 11/28/2022] Open
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Ultrasound-guided vacuum assisted breast biopsy in the assessment of C3 breast lesions by ultrasound-guided fine needle aspiration cytology: results and costs in comparison with surgery. Breast 2009; 18:73-7. [PMID: 19342236 DOI: 10.1016/j.breast.2009.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 01/08/2009] [Accepted: 01/10/2009] [Indexed: 11/22/2022] Open
Abstract
Breast lesions defined C3 at ultrasound (US)-guided fine needle aspiration cytology (FNAC) are probably benign, but exhibit atypias. We evaluate the results of US-guided vacuum assisted breast biopsy (VABB) of these lesions. Patients diagnosed C3 by US-FNAC, submitted to US-VABB and with a minimum follow-up of 36 months or surgery were enrolled. Cost outcome of this diagnostic protocol was evaluated. We evaluated 138 patients with non-palpable C3 lesions. In 2/138 (1.4%) cases VABB results were inadequate. VABB diagnosed: 17/138 (12.3%) malignant and 119/138 (86.2%) benign lesions. In 28/138 cases (20.3%) surgery retrieved 18/28 (64.3%) malignant lesions. One false negative result of VABB was observed. Sensitivity and specificity of VABB resulted 94.4% and 100%. Our diagnostic algorithm estimated a 45% mean decrease of costs using VABB when compared with surgical biopsy of all C3 lesions.
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