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Yang X, Liu F, Li C, Li Z, Wang P, Zhang M, Liu Y, Zhou C, Li Y, Chai Z, Gu X, Xiao X, Li G. Clinicopathological, immunohistochemical and molecular features of acinic cell carcinoma of the breast. Oncol Lett 2024; 27:107. [PMID: 38304172 PMCID: PMC10831401 DOI: 10.3892/ol.2024.14241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/31/2023] [Indexed: 02/03/2024] Open
Abstract
Breast acinic cell carcinoma (ACC) is a rare subtype of breast cancer. Accurate diagnosis of ACC using core needle biopsy (CNB) is pivotal for the use of effective treatments and patient prognosis. In the present study, a detailed analysis of the morphological, immunohistochemical and gene mutation features of 2 cases of ACC was performed. CNB was performed prior to surgical excision. The breast ACC in the present cases exhibited overt burrowing labyrinthine networks or 'hand-holding-hand' features. The tumor cells in both of the present cases expressed cytokeratin (CK)7, S100 and CK5/6, but were negative for p63, estrogen receptor and progesterone receptor. GATA binding protein 3 was positive in case 1 but negative in case 2. Fluorescence in situ hybridization indicated no ETS variant transcription factor 6 break-apart probe detection. Next-generation sequencing results revealed the same mutation and a similar abundance in exon 27 (NM_005120.2; c.3817G>T; p.A1273S) of the mediator of RNA polymerase II transcription, subunit 12 homolog (MED12) gene in both patients. To conclude, the findings of the present study suggested that recognition of this rare 'hand-holding-hand' structure could potentially be beneficial for avoiding patient misdiagnosis. In addition, it could be suggested that a mutation in the MED12 exon 27 was associated with the formation of a burrowing labyrinthine network or 'hand-holding-hand' feature.
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Affiliation(s)
- Xinhua Yang
- Department of Oncology, People's Liberation Army 989 Hospital, Pingdingshan, Henan 467000, P.R. China
| | - Fangyun Liu
- Department of Pathology, Hangzhou Fenlan Medical Laboratory, Hangzhou, Zhejiang 310056, P.R. China
| | - Congyang Li
- Department of Pathology, People's Liberation Army 989 Hospital, Pingdingshan, Henan 467000, P.R. China
| | - Zuo Li
- Department of Endocrinology, People's Liberation Army 989 Hospital, Pingdingshan, Henan 467000, P.R. China
| | - Peipei Wang
- Department of Radiology, People's Liberation Army 989 Hospital, Pingdingshan, Henan 467000, P.R. China
| | - Meng Zhang
- Department of Pathology, People's Liberation Army 989 Hospital, Pingdingshan, Henan 467000, P.R. China
| | - Yanfeng Liu
- Department of Pathology, People's Liberation Army 989 Hospital, Pingdingshan, Henan 467000, P.R. China
| | - Caiwen Zhou
- Department of Pathology, People's Liberation Army 989 Hospital, Pingdingshan, Henan 467000, P.R. China
| | - Yuying Li
- Department of Ultrasonics, People's Liberation Army 989 Hospital, Pingdingshan, Henan 467000, P.R. China
| | - Zhenzhen Chai
- Department of Ultrasonics, People's Liberation Army 989 Hospital, Pingdingshan, Henan 467000, P.R. China
| | - Xiaoguang Gu
- Department of General Surgery, People's Liberation Army 989 Hospital, Pingdingshan, Henan 467000, P.R. China
| | - Xueqing Xiao
- Department of Medical Area, People's Liberation Army 989 Hospital, Pingdingshan, Henan 467000, P.R. China
| | - Guoxia Li
- Department of Pathology, Minhang Hospital, Fudan University, Shanghai 201199, P.R. China
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Masood S, Silverstein MJ. Is it Time to Retire the Term of Low-Grade Ductal Carcinoma in Situ and Replace it With Ductal Neoplasia? Adv Anat Pathol 2023; 30:361-367. [PMID: 37746902 DOI: 10.1097/pap.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
As the leading cause of cancer morbidity and the second leading cause of cancer mortality among women, breast cancer continues to remain a major global public health problem. Consequently, significant attention has been directed toward early breast cancer detection and prevention. As a result, the number of image-detected biopsies has increased, and minimally invasive diagnostic procedures have almost replaced open surgical biopsies. Therefore, pathologists are expected to provide more information with less tissue and diagnose increasing numbers of atypical proliferative breast lesions, in situ lesions, and small breast carcinomas. This is a difficult task, as reflected by continuous reports highlighting the challenges associated with morphologic distinction between atypical ductal hyperplasia and low-grade ductal carcinoma in situ. The current interobserver variability among pathologists to accurately define these two entities often leads to silent overdiagnosis and overtreatment. Up to now, there are no reproducible morphologic features and/or any reliable biomarkers that can accurately separate the above-mentioned entities. Despite these reports, patients diagnosed with low-grade ductal carcinoma in situ are subject to cancer therapy regardless of the fact that low-grade ductal carcinoma in situ is known to be an indolent lesion. Studies have shown that low and high-grade ductal carcinoma in situ are genetically different forms of breast cancer precursors; however, the term ductal carcinoma in situ is followed by cancer therapy regardless of the grade and biology of the tumor. In contrast, patients with the diagnoses of atypical ductal hyperplasia do not undergo cancer therapy. In the current article, attempts are made to highlight the continuous dilemma in distinction between atypical ductal hyperplasia and low-grade ductal carcinoma in situ. Going forward, we suggest that low-grade ductal carcinoma in situ be referred to as ductal neoplasia. This alternative terminology allows for different management and follow-up strategies by eliminating the word carcinoma.
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Affiliation(s)
- Shahla Masood
- Department of Pathology and Laboratory Medicine. University of Florida College of Medicine, Jacksonville
- UF Health Jacksonville Breast Center
- UF Health Jacksonville Laboratories
- UF Health Jacksonville Cancer Program, Jacksonville, FL
| | - Melvin J Silverstein
- Hoag Breast Program, Hoag Memorial Hospital Presbyterian, Newport Beach
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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Calle C, Zhong E, Hanna MG, Ventura K, Friedlander MA, Morrow M, Cody H, Brogi E. Changes in the Diagnoses of Breast Core Needle Biopsies on Second Review at a Tertiary Care Center: Implications for Surgical Management. Am J Surg Pathol 2023; 47:172-182. [PMID: 36638314 PMCID: PMC10464622 DOI: 10.1097/pas.0000000000002002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Core needle biopsy (CNB) of breast lesions is routine for diagnosis and treatment planning. Despite refinement of diagnostic criteria, the diagnosis of breast lesions on CNB can be challenging. At many centers, including ours, confirmation of diagnoses rendered in other laboratories is required before treatment planning. We identified CNBs first diagnosed elsewhere that were reviewed in our department over the course of 1 year because the patients sought care at our center and in which a change in diagnosis had been recorded. The outside and in-house CNB diagnoses were then classified based on Breast WHO Fifth Edition diagnostic categories. The impact of the change in diagnosis was estimated based on the subsequent surgical management. Findings in follow-up surgical excisions (EXCs) were used for validation. In 2018, 4950 outside cases with CNB were reviewed at our center. A total of 403 CNBs diagnoses were discrepant. Of these, 147 had a change in the WHO diagnostic category: 80 (54%) CNBs had a more severe diagnosis and 44 (30%) a less severe diagnosis. In 23 (16%) CNBs, the change of diagnostic category had no impact on management. Intraductal proliferations (n=54), microinvasive carcinoma (n=18), and papillary lesions (n=35) were the most disputed diagnoses. The in-house CNB diagnosis was confirmed in most cases with available excisions. Following CNB reclassification, 22/147 (15%) lesions were not excised. A change affecting the surgical management at our center occurred in 2.5% of all CNBs. Our results support routine review of outside breast CNB as a clinically significant practice before definitive treatment.
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Affiliation(s)
- Catarina Calle
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
- Faculdade de Ciencias da Saude da Universidade da Beira Interior, Covilha, Portugal
| | - Elaine Zhong
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Matthew G. Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Katia Ventura
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Maria A. Friedlander
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Monica Morrow
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Hiram Cody
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
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Agbley BLY, Li J, Hossin MA, Nneji GU, Jackson J, Monday HN, James EC. Federated Learning-Based Detection of Invasive Carcinoma of No Special Type with Histopathological Images. Diagnostics (Basel) 2022; 12:diagnostics12071669. [PMID: 35885573 PMCID: PMC9323034 DOI: 10.3390/diagnostics12071669] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Invasive carcinoma of no special type (IC-NST) is known to be one of the most prevalent kinds of breast cancer, hence the growing research interest in studying automated systems that can detect the presence of breast tumors and appropriately classify them into subtypes. Machine learning (ML) and, more specifically, deep learning (DL) techniques have been used to approach this problem. However, such techniques usually require massive amounts of data to obtain competitive results. This requirement makes their application in specific areas such as health problematic as privacy concerns regarding the release of patients’ data publicly result in a limited number of publicly available datasets for the research community. This paper proposes an approach that leverages federated learning (FL) to securely train mathematical models over multiple clients with local IC-NST images partitioned from the breast histopathology image (BHI) dataset to obtain a global model. First, we used residual neural networks for automatic feature extraction. Then, we proposed a second network consisting of Gabor kernels to extract another set of features from the IC-NST dataset. After that, we performed a late fusion of the two sets of features and passed the output through a custom classifier. Experiments were conducted for the federated learning (FL) and centralized learning (CL) scenarios, and the results were compared. Competitive results were obtained, indicating the positive prospects of adopting FL for IC-NST detection. Additionally, fusing the Gabor features with the residual neural network features resulted in the best performance in terms of accuracy, F1 score, and area under the receiver operation curve (AUC-ROC). The models show good generalization by performing well on another domain dataset, the breast cancer histopathological (BreakHis) image dataset. Our method also outperformed other methods from the literature.
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Affiliation(s)
- Bless Lord Y. Agbley
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China; (B.L.Y.A.); (H.N.M.)
| | - Jianping Li
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China; (B.L.Y.A.); (H.N.M.)
- Correspondence:
| | - Md Altab Hossin
- School of Innovation and Entrepreneurship, Chengdu University, Chengdu 610106, China;
| | - Grace Ugochi Nneji
- School of Information and Software Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China; (G.U.N.); (J.J.); (E.C.J.)
| | - Jehoiada Jackson
- School of Information and Software Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China; (G.U.N.); (J.J.); (E.C.J.)
| | - Happy Nkanta Monday
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China; (B.L.Y.A.); (H.N.M.)
| | - Edidiong Christopher James
- School of Information and Software Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China; (G.U.N.); (J.J.); (E.C.J.)
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Zhou Y, Liang Y, Zhang J, Feng Y, Li X, Kong X, Ma T, Jiang L, Yang Q. Evaluation of Carbon Nanoparticle Suspension and Methylene Blue Localization for Preoperative Localization of Nonpalpable Breast Lesions: A Comparative Study. Front Surg 2021; 8:757694. [PMID: 34888344 PMCID: PMC8651243 DOI: 10.3389/fsurg.2021.757694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The resection of nonpalpable breast lesions (NPBLs) largely depends on the preoperative localization technology. Although several techniques have been used for the guidance of NPBL resection, more comfortable and effective methods are needed. This aim of this study was to evaluate the use and feasibility of carbon nanoparticle suspension (CNS) and methylene blue (MB)-guided resection of NPBL, to introduce alternative techniques. Methods: A total of 105 patients with 172 NPBLs detected by breast ultrasound were randomized to CNS localization (CNSL) group and MB localization (MBL) group. The injection times of the two groups were divided into 2, 4, 6, 12, 16, and 20 h before surgery. In this study, localization time, stained area, operation time, total resection volume (TRV), calculated resection ratio (CRR), and pathological diagnosis were assessed. Results: All of the 172 lesions were finally confirmed benign. Dye persisted in all cases in the CNSL group (109/109, 100%), while that persisted in only 53 cases in the MBL group (53/63, 84.1%) (P < 0.001). There was a significant correlation between dyeing time and dyeing area in the MBL group (r = −0.767, P < 0.001); however, there was no significant correlation in the CNSL group (r = −0.154, P = 0.110). The operation time was 11.05 ± 3.40 min in the CNSL group and 13.48 ± 6.22 min in the MBL group (P < 0.001). The TRV was 2.51 ± 2.42 cm3 in the CNSL group and 3.69 ± 3.24 cm3 in the MBL group (P = 0.016). For CRR, the CNSL group was lower than the MBL group (7.62 ± 0.49 vs. 21.93 ± 78.00, P = 0.018). There is no dye remained on the skin in the MBL group; however, dye persisted in 12 patients (19.4%) in the CNSL group (P = 0.001). Conclusion: Carbon nanoparticle suspension localization and MBL are technically applicable and clinically acceptable procedures for intraoperatively localizing NPBL. Moreover, given the advantages of CNSL compared to MBL, including the ability to perform this technique 5 days before operation and smaller resection volume, it seems to be a more attractive alternative to be used in intraoperative localization of NPBL.
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Affiliation(s)
- Yeqing Zhou
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yiran Liang
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jianshu Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yang Feng
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoyan Li
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoli Kong
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tingting Ma
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liyu Jiang
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qifeng Yang
- Department of Breast Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Pathology Tissue Bank, Qilu Hospital of Shandong University, Jinan, China.,Research Institute of Breast Cancer, Shandong University, Jinan, China
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Kanavati F, Tsuneki M. Breast Invasive Ductal Carcinoma Classification on Whole Slide Images with Weakly-Supervised and Transfer Learning. Cancers (Basel) 2021; 13:cancers13215368. [PMID: 34771530 PMCID: PMC8582388 DOI: 10.3390/cancers13215368] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary In this study, we have trained deep learning models using transfer learning and weakly-supervised learning for the classification of breast invasive ductal carcinoma (IDC) in whole slide images (WSIs). We evaluated the models on four test sets: one biopsy (n = 522) and three surgical (n = 1129) achieving AUCs in the range 0.95 to 0.99. We have also compared the trained models to existing pre-trained models on different organs for adenocarcinoma classification and they have achieved lower AUC performances in the range 0.66 to 0.89 despite adenocarcinoma exhibiting some structural similarity to IDC. Therefore, performing fine-tuning on the breast IDC training set was beneficial for improving performance. The results demonstrate the potential use of such models to aid pathologists in clinical practice. Abstract Invasive ductal carcinoma (IDC) is the most common form of breast cancer. For the non-operative diagnosis of breast carcinoma, core needle biopsy has been widely used in recent years for the evaluation of histopathological features, as it can provide a definitive diagnosis between IDC and benign lesion (e.g., fibroadenoma), and it is cost effective. Due to its widespread use, it could potentially benefit from the use of AI-based tools to aid pathologists in their pathological diagnosis workflows. In this paper, we trained invasive ductal carcinoma (IDC) whole slide image (WSI) classification models using transfer learning and weakly-supervised learning. We evaluated the models on a core needle biopsy (n = 522) test set as well as three surgical test sets (n = 1129) obtaining ROC AUCs in the range of 0.95–0.98. The promising results demonstrate the potential of applying such models as diagnostic aid tools for pathologists in clinical practice.
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Clinical practice guidelines for diagnosis and treatment of patients with non-puerperal mastitis: Chinese Society of Breast Surgery (CSBrS) practice guideline 2021. Chin Med J (Engl) 2021; 134:1765-1767. [PMID: 34039865 PMCID: PMC8367070 DOI: 10.1097/cm9.0000000000001532] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Deygas F, Amadou A, Coudon T, Grassot L, Couvidat F, Bessagnet B, Faure E, Salizzoni P, Gulliver J, Caudeville J, Severi G, Mancini FR, Leffondré K, Fervers B, Praud D. Long-term atmospheric exposure to PCB153 and breast cancer risk in a case-control study nested in the French E3N cohort from 1990 to 2011. ENVIRONMENTAL RESEARCH 2021; 195:110743. [PMID: 33450235 DOI: 10.1016/j.envres.2021.110743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/18/2020] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although the genetic and hormonal risk factors of breast cancer are well identified, they cannot fully explain the occurrence of all cases. Epidemiological and experimental studies have suggested that exposure to environmental pollutants, especially those with potential estrogenic properties, as polychlorinated biphenyls (PCBs) may have a role in breast cancer development. Being the most abundantly detected in human tissues and in the environment, congener 153 (PCB153) is widely used in epidemiological studies as indicator for total PCBs exposure. OBJECTIVES We aimed to estimate the association between cumulative atmospheric exposure to PCB153 and breast cancer risk. METHODS We conducted a case-control study of 5222 cases and 5222 matched controls nested within the French E3N cohort from 1990 to 2011. Annual atmospheric PCB153 concentrations were simulated with the deterministic chemistry-transport model (CHIMERE) and were assigned to women using their geocoded residential history. Their cumulative PCB153 exposure was calculated for each woman from their cohort inclusion to their index date. Breast cancer odds ratios (ORs) associated with cumulative PCB153 exposure and their 95% confidence intervals (95% CIs) were estimated using multivariate conditional logistic regression models. RESULTS Overall, our results showed a statistically significant linear increase in breast cancer risk related to cumulative atmospheric exposure to PCB153 as a continuous variable (adjusted OR = 1.19; 95% CI: 1.08-1.31, for an increment of one standard deviation among controls (55 pg/m3)). Among women who became postmenopausal during follow-up, the association remained statistically significant (adjusted OR = 1.23; 95% CI: 1.09-1.39). In analyses by hormone receptors status, the positive association remained significant only for ER-positive breast cancer (adjusted OR = 1.18; 95% CI: 1.05-1.33). DISCUSSION This study is the first to have estimated the impact of atmospheric exposure to PCB153 on breast cancer risk. Our results showed a statistically significant increase in breast cancer risk, which may be limited to ER-positive breast cancer. These results warrant confirmation in further independent studies but raise the possibility that exposure to PCB153 increase breast cancer risk.
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Affiliation(s)
- Floriane Deygas
- Department of Prevention, Cancer and Environment, Centre Léon Bérard, Lyon, France; Inserm U1296, "Radiation: Defense, Health and Environment", Centre Léon Bérard, Lyon, France
| | - Amina Amadou
- Department of Prevention, Cancer and Environment, Centre Léon Bérard, Lyon, France; Inserm U1296, "Radiation: Defense, Health and Environment", Centre Léon Bérard, Lyon, France
| | - Thomas Coudon
- Department of Prevention, Cancer and Environment, Centre Léon Bérard, Lyon, France; Inserm U1296, "Radiation: Defense, Health and Environment", Centre Léon Bérard, Lyon, France; Ecole Centrale de Lyon, University Claude Bernard Lyon 1, Ecully, France
| | - Lény Grassot
- Department of Prevention, Cancer and Environment, Centre Léon Bérard, Lyon, France; Inserm U1296, "Radiation: Defense, Health and Environment", Centre Léon Bérard, Lyon, France
| | - Florian Couvidat
- National Institute for Industrial Environment and Risks (INERIS), Verneuil-en-Halatte, France
| | - Bertrand Bessagnet
- National Institute for Industrial Environment and Risks (INERIS), Verneuil-en-Halatte, France; Citepa, Technical Reference Center for Air Pollution and Climate Change, Paris, France
| | - Elodie Faure
- Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP), Team "Exposome and Heredity", Gustave Roussy, Villejuif, France
| | - Pietro Salizzoni
- Ecole Centrale de Lyon, University Claude Bernard Lyon 1, Ecully, France
| | - John Gulliver
- Centre for Environmental Health and Sustainability, School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Julien Caudeville
- National Institute for Industrial Environment and Risks (INERIS), Verneuil-en-Halatte, France
| | - Gianluca Severi
- Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP), Team "Exposome and Heredity", Gustave Roussy, Villejuif, France; Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Italy
| | - Francesca Romana Mancini
- Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP), Team "Exposome and Heredity", Gustave Roussy, Villejuif, France.
| | - Karen Leffondré
- University of Bordeaux, ISPED, Inserm U1219, Bordeaux Population Health Center, Bordeaux, France
| | - Béatrice Fervers
- Department of Prevention, Cancer and Environment, Centre Léon Bérard, Lyon, France; Inserm U1296, "Radiation: Defense, Health and Environment", Centre Léon Bérard, Lyon, France.
| | - Delphine Praud
- Department of Prevention, Cancer and Environment, Centre Léon Bérard, Lyon, France; Inserm U1296, "Radiation: Defense, Health and Environment", Centre Léon Bérard, Lyon, France
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Bennett IC, Saboo A. The Evolving Role of Vacuum Assisted Biopsy of the Breast: A Progression from Fine-Needle Aspiration Biopsy. World J Surg 2019; 43:1054-1061. [PMID: 30617562 DOI: 10.1007/s00268-018-04892-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The management of breast disease has been greatly facilitated by the technology of needle biopsy interventions, and over the past 30 years, this has evolved from the use of fine-needle aspiration biopsy (FNAB) to the current methodology of vacuum assisted biopsy (VAB). METHODS This article provides an historical review of the application of needle interventions of the breast in the diagnosis and management of breast conditions, and discusses current indications for the use of vacuum assisted biopsies and vacuum assisted excisions. RESULTS Whilst FNAB continues to have a limited role in breast disease diagnosis, the necessity of achieving an histological diagnosis has preferentially seen the development and wider application of automated core needle biopsies (CNB) and VAB in the assessment and management of breast lesions. The advantages of CNB and VAB include the ability to distinguish in situ and invasive disease pre-operatively, and the ability to achieve prior knowledge of immunohistochemical tumour markers particularly in the setting of neoadjuvant drug treatments. CONCLUSION Due to its ability to obtain larger tissue samples, VAB does have diagnostic advantages over CNB and indications for the utilization of VAB are discussed. VAB additionally has an expanding role as a tool for breast lesion excision.
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Affiliation(s)
- Ian C Bennett
- Breast and Endocrine Surgical Unit, Princess Alexandra Hospital, University of Queensland, Woolloongabba, Brisbane, QLD, Australia.
| | - Apoorva Saboo
- Breast and Endocrine Surgical Unit, Princess Alexandra Hospital, University of Queensland, Woolloongabba, Brisbane, QLD, Australia
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Can tumor-associated macrophages in ductal carcinoma in situ on biopsy predict invasive carcinoma on excision? Hum Pathol 2018; 82:158-162. [PMID: 30067949 DOI: 10.1016/j.humpath.2018.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/12/2018] [Accepted: 07/21/2018] [Indexed: 01/08/2023]
Abstract
Recent trials have explored surveillance of ductal carcinoma in situ (DCIS) without complete excision, but it is difficult to fully exclude an associated, unsampled invasive focus. Tumor microenvironment, including tumor-associated macrophages, may play a role in the transition from in situ to invasive carcinoma, and the presence of CD163-positive cells with DCIS has been associated with increased risk of progression to invasive carcinoma. We aimed to evaluate the role of DCIS-associated CD163-positive cells on biopsy in predicting associated invasion on excision. Immunohistochemistry for CD163 was performed on 57 total biopsy cases of DCIS of low (n = 13), intermediate (n = 21), and high (n = 23) nuclear grade, 27 (47%) of which showed invasion on the subsequent excision specimen. Positive intratumoral and stromal cells were quantified independently by 2 observers based on the percentage of cells staining. Intratumoral CD163 scores ranged from 0 to 2 (mean, 0.7). Stromal CD163 scores ranged from 0 to 3 (mean, 1.3). Intratumoral and stromal CD163 levels were not significantly associated with the presence of subsequent invasion when evaluated as a whole group (P = .36 and P = .47) or when subdivided into low (P = .36 and P = .17), intermediate (P = .82 and P = .82), or high (P = .09 and P = .68) nuclear grades. There was no correlation between intratumoral CD163 content and DCIS grade (P = .257). A trend for higher stromal CD163 expression was seen with higher-grade DCIS, although not statistically significant (P = .178). In conclusion, CD163 on breast core biopsy does not help select patients who may safely forgo excision of DCIS.
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Segnan N, Minozzi S, Ponti A, Bellisario C, Balduzzi S, González-Lorenzo M, Gianola S, Armaroli P. Estimate of false-positive breast cancer diagnoses from accuracy studies: a systematic review. J Clin Pathol 2017; 70:282-294. [DOI: 10.1136/jclinpath-2016-204184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 11/04/2022]
Abstract
BackgroundFalse-positive histological diagnoses have the same consequences of overdiagnosis in terms of unnecessary treatment. The aim of this systematic review is to assess their frequency at needle core biopsy (CB) and/or surgical excision of the breast.MethodsPubMed, Embase, Cochrane Library were systematically searched up to 30 October 2015. Eligibility criteria: cross-sectional studies assessing diagnostic accuracy of CB compared with surgical excision; studies assessing reproducibility of pathologists reading the same slides. Outcomes: false-positive rates; Misclassification of Benign as Malignant (MBM) histological diagnosis; K statistic. Independent reviewers extracted data and assessed quality using an adapted QUADAS-2 tool.ResultsSixteen studies assessed CB false-positive rates. In 10 studies (41 989 screen-detected lesions), the range of false-positive rates was 0%–7.1%. Twenty-seven studies assessed pathologists' reproducibility. Studies with consecutive, random or stratified samples of all the specimens: at CB the MBM range was 0.25%–2.4% (K values 0.83–0.98); at surgical excision, it was 0.67%–1.2% (K values 0.86–0.94). Studies with enriched samples: the MBM range was 1.4%–6.2% (K values 0.57–0.86). Studies of cases selected for second opinion: the MBM range was 0.29%–12.2% (K values 0.48 and 0.50).ConclusionsHigh heterogeneity of the included studies precluded formal pooling estimates. When considering studies of higher sample size or methodological quality, false-positive rates and MBM are around 1%. The impact of false-positive histological diagnoses of breast cancer on unnecessary treatment, as well as that of overdiagnosis, is not negligible and is of importance in clinical practice.
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Chen J, Wang Z, Lv Q, Du Z, Tan Q, Zhang D, Xiong B, Zeng H, Gou J. Comparison of Core Needle Biopsy and Excision Specimens for the Accurate Evaluation of Breast Cancer Molecular Markers: a Report of 1003 Cases. Pathol Oncol Res 2017; 23:769-775. [PMID: 28074330 DOI: 10.1007/s12253-017-0187-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/02/2017] [Indexed: 02/05/2023]
Abstract
In this study, we compared the accuracy of marker evaluation in core needle biopsy (CNB) specimens versus excision specimens (ESs) from breast cancer patients. This retrospective study used data collected from the breast cancer database at the West China Hospital, China. Immunohistochemistry (IHC) results from CNB specimens and ESs were compared, using estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 as markers. Molecular subtyping and endocrine therapy usage correlations based on CNB samples and ESs were evaluated. The results obtained from CNB samples and ESs exhibited substantial agreement for the detection of ER (κ = 0.522), PR (κ = 0.441), and HER2 (κ = 0.451), and also influenced endocrine therapy usage. Fair and poor correlations were observed for Ki-67 staining and molecular subtyping (κ = 0.195), respectively. This disagreement might be attributable to a combination of heterogeneity and large tumor size. This study indicates that the discordance rate in molecular marker staining between CNB specimens and ESs is significant enough that results obtained with CNB specimens should be used cautiously or verified using ESs.
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Affiliation(s)
- Jie Chen
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zu Wang
- Tumor Molecular Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Qing Lv
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Zhenggui Du
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Qiuwen Tan
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | | | | | - Helin Zeng
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Juxiang Gou
- Department of Breast and Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
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Allison KH, Rendi MH, Peacock S, Morgan T, Elmore JG, Weaver DL. Histological features associated with diagnostic agreement in atypical ductal hyperplasia of the breast: illustrative cases from the B-Path study. Histopathology 2016; 69:1028-1046. [PMID: 27398812 DOI: 10.1111/his.13035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/08/2016] [Indexed: 01/26/2023]
Abstract
AIMS This study examined the case-specific characteristics associated with interobserver diagnostic agreement in atypical ductal hyperplasia (ADH) of the breast. METHODS AND RESULTS Seventy-two test set cases with a consensus diagnosis of ADH from the B-Path study were evaluated. Cases were scored for 17 histological features, which were then correlated with the participant agreement with the consensus ADH diagnosis. Participating pathologists' perceptions of case difficulty, borderline features or whether they would obtain a second opinion were also examined for associations with agreement. Of the 2070 participant interpretations of the 72 consensus ADH cases, 48% were scored by participants as difficult and 45% as borderline between two diagnoses; the presence of both of these features was significantly associated with increased agreement (P < 0.001). A second opinion would have been obtained in 80% of interpretations, and this was associated with increased agreement (P < 0.001). Diagnostic agreement ranged from 10% to 89% on a case-by-case basis. Cases with papillary lesions, cribriform architecture and obvious cytological monotony were associated with higher agreement. Lower agreement rates were associated with solid or micropapillary architecture, borderline cytological monotony, or cases without a diagnostic area that was obvious on low power. CONCLUSIONS The results of this study suggest that pathologists frequently recognize the challenge of ADH cases, with some cases being more prone to diagnostic variability. In addition, there are specific histological features associated with diagnostic agreement on ADH cases. Multiple example images from cases in this test set are provided to serve as educational illustrations of these challenges.
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Affiliation(s)
- Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mara H Rendi
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Sue Peacock
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Tom Morgan
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Donald L Weaver
- Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA
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Bhayroo S, Perumal LY, Buccimazza I. A retrospective analysis of ultrasound-guided large core needle biopsies of breast lesions at a regional public hospital in Durban, KwaZulu-Natal, South Africa. SA J Radiol 2016. [DOI: 10.4102/sajr.v20i1.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Histological confirmation of a breast lesion is an important step to determine the aetiology and direct further management. Evidence supports ultrasound-guided large core needle biopsy (US-LCNB) (14 gauge) as the preferred diagnostic method over traditional open surgical biopsy.Objective: To assess the influence of technical variables on the diagnostic yield of breast specimens obtained by using US-LCNB, and the sensitivity of detecting malignancy during the study period.Methods: A retrospective chart review was conducted of all patients who had US-LCNBs from March 2011 – September 2012 at Addington Hospital in Durban, KwaZulu-Natal. Histopathological findings were correlated to the size of the breast lesion, rank of the radiologist performing the procedure and the number of cores obtained. The sensitivity of the technique was determined.Results: During the study period, 147 biopsies were performed. The majority of lesions were>5 mm (85.5%). The average number of cores was 4, and 79.5% of the biopsies were performed by the senior radiologist. Of the 147 biopsies, 132 specimens were eligible for inclusion in the study. Histopathology revealed 71 malignant lesions of which 60 were confirmed histologically at excision. In 11 patients, no excision was performed. Therefore, the sensitivity of detecting malignancy was 100%.Conclusion: Although the study did not establish a statistically significant relationship between the above mentioned technical variables and the histological outcome, the overall diagnostic yield and the sensitivity of detecting malignancy using US-LCNB is comparable to other similar international studies. A prospective study with long-term follow-up of patients would be of value.
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Calhoun BC, Collins LC. Recommendations for excision following core needle biopsy of the breast: a contemporary evaluation of the literature. Histopathology 2015; 68:138-51. [DOI: 10.1111/his.12852] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | - Laura C Collins
- Department of Pathology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
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Soofi Y, Khoury T. Inter-Institutional Pathology Consultation: The Importance of Breast Pathology Subspecialization in a Setting of Tertiary Cancer Center. Breast J 2015; 21:337-44. [DOI: 10.1111/tbj.12420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yousef Soofi
- Department of Pathology; Roswell Park Cancer Institute; Buffalo New York
| | - Thaer Khoury
- Department of Pathology; Roswell Park Cancer Institute; Buffalo New York
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Elmore JG, Longton GM, Carney PA, Geller BM, Onega T, Tosteson ANA, Nelson HD, Pepe MS, Allison KH, Schnitt SJ, O'Malley FP, Weaver DL. Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA 2015; 313:1122-32. [PMID: 25781441 PMCID: PMC4516388 DOI: 10.1001/jama.2015.1405] [Citation(s) in RCA: 365] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE A breast pathology diagnosis provides the basis for clinical treatment and management decisions; however, its accuracy is inadequately understood. OBJECTIVES To quantify the magnitude of diagnostic disagreement among pathologists compared with a consensus panel reference diagnosis and to evaluate associated patient and pathologist characteristics. DESIGN, SETTING, AND PARTICIPANTS Study of pathologists who interpret breast biopsies in clinical practices in 8 US states. EXPOSURES Participants independently interpreted slides between November 2011 and May 2014 from test sets of 60 breast biopsies (240 total cases, 1 slide per case), including 23 cases of invasive breast cancer, 73 ductal carcinoma in situ (DCIS), 72 with atypical hyperplasia (atypia), and 72 benign cases without atypia. Participants were blinded to the interpretations of other study pathologists and consensus panel members. Among the 3 consensus panel members, unanimous agreement of their independent diagnoses was 75%, and concordance with the consensus-derived reference diagnoses was 90.3%. MAIN OUTCOMES AND MEASURES The proportions of diagnoses overinterpreted and underinterpreted relative to the consensus-derived reference diagnoses were assessed. RESULTS Sixty-five percent of invited, responding pathologists were eligible and consented to participate. Of these, 91% (N = 115) completed the study, providing 6900 individual case diagnoses. Compared with the consensus-derived reference diagnosis, the overall concordance rate of diagnostic interpretations of participating pathologists was 75.3% (95% CI, 73.4%-77.0%; 5194 of 6900 interpretations). Among invasive carcinoma cases (663 interpretations), 96% (95% CI, 94%-97%) were concordant, and 4% (95% CI, 3%-6%) were underinterpreted; among DCIS cases (2097 interpretations), 84% (95% CI, 82%-86%) were concordant, 3% (95% CI, 2%-4%) were overinterpreted, and 13% (95% CI, 12%-15%) were underinterpreted; among atypia cases (2070 interpretations), 48% (95% CI, 44%-52%) were concordant, 17% (95% CI, 15%-21%) were overinterpreted, and 35% (95% CI, 31%-39%) were underinterpreted; and among benign cases without atypia (2070 interpretations), 87% (95% CI, 85%-89%) were concordant and 13% (95% CI, 11%-15%) were overinterpreted. Disagreement with the reference diagnosis was statistically significantly higher among biopsies from women with higher (n = 122) vs lower (n = 118) breast density on prior mammograms (overall concordance rate, 73% [95% CI, 71%-75%] for higher vs 77% [95% CI, 75%-80%] for lower, P < .001), and among pathologists who interpreted lower weekly case volumes (P < .001) or worked in smaller practices (P = .034) or nonacademic settings (P = .007). CONCLUSIONS AND RELEVANCE In this study of pathologists, in which diagnostic interpretation was based on a single breast biopsy slide, overall agreement between the individual pathologists' interpretations and the expert consensus-derived reference diagnoses was 75.3%, with the highest level of concordance for invasive carcinoma and lower levels of concordance for DCIS and atypia. Further research is needed to understand the relationship of these findings with patient management.
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Affiliation(s)
- Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Gary M Longton
- Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Patricia A Carney
- Department of Family Medicine, Oregon Health and Science University, Portland
| | - Berta M Geller
- Department of Family Medicine, University of Vermont, Vineyard Haven, Massachusetts
| | - Tracy Onega
- Department of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Anna N A Tosteson
- Department of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire6Department of Medicine, Geisel School of Medicine at
| | - Heidi D Nelson
- Providence Cancer Center, Providence Health and Services Oregon, Portland8Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland9Department of Clinical Epidemiology and Medicine, Oregon Health and Scien
| | - Margaret S Pepe
- Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Stuart J Schnitt
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts12Harvard Medical School, Boston, Massachusetts
| | - Frances P O'Malley
- Department of Laboratory Medicine and the Keenan Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada14St Michael's Hospital and the University of Toronto, Ontario, Canada
| | - Donald L Weaver
- Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington
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Colin C, Devouassoux-Shisheboran M, Sardanelli F. Is breast cancer overdiagnosis also nested in pathologic misclassification? Radiology 2015; 273:652-5. [PMID: 25420166 DOI: 10.1148/radiol.14141116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Catherine Colin
- From the Radiology Unit, Hospices Civils de Lyon, Centre Hospitalo-Universitaire Lyon Sud, 69495 Pierre Bénite Cedex, France (C.C.); Pathology Unit, Hospices Civils de Lyon, Hôpital de la Croix Rousse 103, Lyon, France (M.D.S.); Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.); and Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (F.S.)
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Demographic and practice characteristics of pathologists who enjoy breast tissue interpretation. Breast 2015; 24:107-11. [PMID: 25554017 DOI: 10.1016/j.breast.2014.10.003] [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: 01/16/2014] [Revised: 09/04/2014] [Accepted: 10/12/2014] [Indexed: 11/20/2022] Open
Abstract
Physician attributes, job satisfaction and confidence in clinical skills are associated with enhanced performance and better patient outcomes. We surveyed 252 pathologists to evaluate associations between enjoyment of breast pathology, demographic/clinical characteristics and diagnostic performance. Diagnostic performance was determined by comparing pathologist assessments of a set of 60 cases with consensus assessments of the same cases made by a panel of experienced pathologists. Eighty-three percent of study participants reported enjoying breast pathology. Pathologists who enjoy breast interpretation were more likely to review ≥10 cases/week (p = 0.003), report breast interpretation expertise (p = 0.013) and have high levels of confidence interpreting breast pathology (p < 0.001). These pathologists were less likely to report that the field was challenging (p < 0.001) and that breast cases make them more nervous than other types of pathology (p < 0.001). Enjoyment was not associated with diagnostic performance. Millions of women undergo breast biopsy annually, thus it is reassuring that although nearly a fifth of practicing pathologists who interpret breast tissue report not enjoying the field, precision is not impacted.
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Dobbs J, Krishnamurthy S, Kyrish M, Benveniste AP, Yang W, Richards-Kortum R. Confocal fluorescence microscopy for rapid evaluation of invasive tumor cellularity of inflammatory breast carcinoma core needle biopsies. Breast Cancer Res Treat 2014; 149:303-10. [PMID: 25417171 PMCID: PMC4298669 DOI: 10.1007/s10549-014-3182-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/24/2014] [Indexed: 11/27/2022]
Abstract
Tissue sampling is a problematic issue for inflammatory breast carcinoma, and immediate evaluation following core needle biopsy is needed to evaluate specimen adequacy. We sought to determine if confocal fluorescence microscopy provides sufficient resolution to evaluate specimen adequacy by comparing invasive tumor cellularity estimated from standard histologic images to invasive tumor cellularity estimated from confocal images of breast core needle biopsy specimens. Grayscale confocal fluorescence images of breast core needle biopsy specimens were acquired following proflavine application. A breast-dedicated pathologist evaluated invasive tumor cellularity in histologic images with hematoxylin and eosin staining and in grayscale and false-colored confocal images of cores. Agreement between cellularity estimates was quantified using a kappa coefficient. 23 cores from 23 patients with suspected inflammatory breast carcinoma were imaged. Confocal images were acquired in an average of less than 2 min per core. Invasive tumor cellularity estimated from histologic and grayscale confocal images showed moderate agreement by kappa coefficient: κ = 0.48 ± 0.09 (p < 0.001). Grayscale confocal images require less than 2 min for acquisition and allow for evaluation of invasive tumor cellularity in breast core needle biopsy specimens with moderate agreement to histologic images. We show that confocal fluorescence microscopy can be performed immediately following specimen acquisition and could indicate the need for additional biopsies at the initial visit.
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Affiliation(s)
- Jessica Dobbs
- Department of Bioengineering, Rice University, 6500 Main Street, BRC 502, Houston, TX 77030 USA
| | - Savitri Krishnamurthy
- Department of Pathology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX 77030 USA
| | - Matthew Kyrish
- Department of Bioengineering, Rice University, 6500 Main Street, BRC 502, Houston, TX 77030 USA
- Present Address: Fresnel Technologies, 101 West Morningside Drive, Fort Worth, TX 76110 USA
| | - Ana Paula Benveniste
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX 77030 USA
| | - Wei Yang
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX 77030 USA
| | - Rebecca Richards-Kortum
- Department of Bioengineering, Rice University, 6500 Main Street, BRC 502, Houston, TX 77030 USA
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Allison KH, Reisch LM, Carney PA, Weaver DL, Schnitt SJ, O'Malley FP, Geller BM, Elmore JG. Understanding diagnostic variability in breast pathology: lessons learned from an expert consensus review panel. Histopathology 2014; 65:240-51. [PMID: 24511905 DOI: 10.1111/his.12387] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/03/2014] [Indexed: 11/30/2022]
Abstract
AIMS To gain a better understanding of the reasons for diagnostic variability, with the aim of reducing the phenomenon. METHODS AND RESULTS In preparation for a study on the interpretation of breast specimens (B-PATH), a panel of three experienced breast pathologists reviewed 336 cases to develop consensus reference diagnoses. After independent assessment, cases coded as diagnostically discordant were discussed at consensus meetings. By the use of qualitative data analysis techniques, transcripts of 16 h of consensus meetings for a subset of 201 cases were analysed. Diagnostic variability could be attributed to three overall root causes: (i) pathologist-related; (ii) diagnostic coding/study methodology-related; and (iii) specimen-related. Most pathologist-related root causes were attributable to professional differences in pathologists' opinions about whether the diagnostic criteria for a specific diagnosis were met, most frequently in cases of atypia. Diagnostic coding/study methodology-related root causes were primarily miscategorizations of descriptive text diagnoses, which led to the development of a standardized electronic diagnostic form (BPATH-Dx). Specimen-related root causes included artefacts, limited diagnostic material, and poor slide quality. After re-review and discussion, a consensus diagnosis could be assigned in all cases. CONCLUSIONS Diagnostic variability is related to multiple factors, but consensus conferences, standardized electronic reporting formats and comments on suboptimal specimen quality can be used to reduce diagnostic variability.
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Affiliation(s)
- Kimberly H Allison
- Department of Pathology, University of Washington Medical Center, Seattle, WA, USA
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Reisenbichler ES, Lester SC, Richardson AL, Dillon DA, Ly A, Brock JE. Interobserver concordance in implementing the 2010 ASCO/CAP recommendations for reporting ER in breast carcinomas: a demonstration of the difficulties of consistently reporting low levels of ER expression by manual quantification. Am J Clin Pathol 2013; 140:487-94. [PMID: 24045544 DOI: 10.1309/ajcp1rf9fuizrdpi] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Endocrine therapy reduces recurrence risk by 30% to 50% in estrogen receptor (ER)-positive breast cancer. The ER-positive threshold recommended by the American Society of Clinical Oncology/College of American Pathologists is 1% based on studies using the ER-6F11 antibody. ER-SP1 antibody has a higher sensitivity and is more widely used. METHODS We report interobserver concordance manually measuring ER in 264 breast cancers using ER-SP1 and 1D5 and 2 scoring methods (H-score and Allred score). RESULTS With both antibodies, 3% to 4% of cases have a low level of ER expression (1%-10%), more than previously reported (<1%). We find a high level of paired observer concordance with both antibodies and scoring methods (κ = 0.892-0.943) with no significant difference with method of scoring. Despite excellent concordance, positive/negative discordance was almost 5% among 3 observers using either antibody, an underappreciated clinically significant rate. CONCLUSIONS Discordance overwhelmingly reflected differing opinions recording the proportion of tumor cells positive with low levels of expression (<10% staining; 12/13 cases).
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Affiliation(s)
| | - Susan C. Lester
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
| | | | | | - Amy Ly
- Massachusetts General Hospital, Boston
| | - Jane E. Brock
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
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Development of a diagnostic test set to assess agreement in breast pathology: practical application of the Guidelines for Reporting Reliability and Agreement Studies (GRRAS). BMC WOMENS HEALTH 2013; 13:3. [PMID: 23379630 PMCID: PMC3610240 DOI: 10.1186/1472-6874-13-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 01/18/2013] [Indexed: 02/07/2023]
Abstract
Background Diagnostic test sets are a valuable research tool that contributes importantly to the validity and reliability of studies that assess agreement in breast pathology. In order to fully understand the strengths and weaknesses of any agreement and reliability study, however, the methods should be fully reported. In this paper we provide a step-by-step description of the methods used to create four complex test sets for a study of diagnostic agreement among pathologists interpreting breast biopsy specimens. We use the newly developed Guidelines for Reporting Reliability and Agreement Studies (GRRAS) as a basis to report these methods. Methods Breast tissue biopsies were selected from the National Cancer Institute-funded Breast Cancer Surveillance Consortium sites. We used a random sampling stratified according to woman’s age (40–49 vs. ≥50), parenchymal breast density (low vs. high) and interpretation of the original pathologist. A 3-member panel of expert breast pathologists first independently interpreted each case using five primary diagnostic categories (non-proliferative changes, proliferative changes without atypia, atypical ductal hyperplasia, ductal carcinoma in situ, and invasive carcinoma). When the experts did not unanimously agree on a case diagnosis a modified Delphi method was used to determine the reference standard consensus diagnosis. The final test cases were stratified and randomly assigned into one of four unique test sets. Conclusions We found GRRAS recommendations to be very useful in reporting diagnostic test set development and recommend inclusion of two additional criteria: 1) characterizing the study population and 2) describing the methods for reference diagnosis, when applicable.
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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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Stang A, Trocchi P, Ruschke K, Schmidt-Pokrzywniak A, Holzhausen HJ, Löning T, Buchmann J, Thomssen C, Lantzsch T, Hauptmann S, Böcker W, Kluttig A. Factors influencing the agreement on histopathological assessments of breast biopsies among pathologists. Histopathology 2012; 59:939-49. [PMID: 22092405 DOI: 10.1111/j.1365-2559.2011.04032.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
AIMS It has been recommended that the histopathology results of core biopsies of the breast are categorized according to the B-categorization scheme. We measured the interobserver variability of the B-categorization of core biopsies of the breast. METHODS AND RESULTS Core biopsies were taken among 765 women at the University of Halle between 2006 and 2008. All histological slides were reviewed in a blinded fashion by two experienced breast pathologists. We calculated observed and chance-corrected agreements (kappa) and 95% confidence intervals (CI). The prevalence of B3-B5 biopsies was 41.6%. The observed and weighted kappa agreement of the five-level B-categorization scheme was 0.87 (95% CI: 0.84 -0.89) and 0.89 (95% CI: 0.89-0.91), respectively. The most frequent disagreement was between B2 and B3 (47 of 103 disagreements, 45.6%). Overall, 49.5% of all disagreements were clinically relevant disagreements that would imply different therapeutic strategies. Agreement was modified by referral group, Breast Imaging Reporting and Data System (BIRADS) level, radiological breast density, imaging guidance and application of immunohistological staining. CONCLUSIONS Interobserver agreement of the B-categorization scheme was high and was modified by referral status, level of radiological suspicion of breast cancer, breast density, imaging guidance of core biopsies and requirement of additional immunohistological staining.
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Affiliation(s)
- Andreas Stang
- Institut für Klinische Epidemiologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany.
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Makkun S, Prueksadee J, Chayakulkheeree J, Boonjunwetwat D. The accuracy of ultrasound guided 14–gauge core needle breast biopsy: Correlation with surgical excision or long term follow–up. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2011. [DOI: 10.1016/s2222-1808(11)60033-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Williams RT, Yao K, Stewart AK, Winchester DJ, Turk M, Gorchow A, Jaskowiak N, Winchester DP. Needle versus excisional biopsy for noninvasive and invasive breast cancer: report from the National Cancer Data Base, 2003-2008. Ann Surg Oncol 2011; 18:3802-10. [PMID: 21630122 DOI: 10.1245/s10434-011-1808-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Needle biopsy to diagnose breast cancer may soon become a quality measure for which hospitals are held accountable. This study examines the utilization of needle versus excisional biopsy in a contemporary cohort of patients and identifies factors associated with biopsy type. METHODS Women with nonmetastatic, clinical Tis-T3 breast cancers diagnosed between 2003 and 2008 were selected from the National Cancer Data Base, which captures information from ~79% of breast cancers in the United States. Patients whose cancer was diagnosed by needle biopsy (fine-needle aspiration or core) were compared with patients diagnosed via excision, analyzing patient, hospital, and tumor characteristics. Logistic regression was used to identify important predictors of biopsy type. RESULTS Of 373,837 patients, 303,677 (81.2%) underwent needle biopsy while 70,160 (18.8%) had excisional biopsy to diagnose their cancer. The needle biopsy rate increased from 73.8 to 86.7% whereas excisional biopsy declined from 26.2 to 13.3% over the study period (P < 0.001). In 2008, patients were statistically significantly more likely to undergo excisional biopsy if they had stage 0 disease; were treated at low-volume (<25 cases/year), community, or Atlantic census region hospitals; were <40 years old at diagnosis; were less educated; or were Asian/Pacific Islander (P < 0.001). The median rate of needle biopsy at high-volume hospitals (≥140 cases/year) was 89.6%. CONCLUSION The use of needle biopsy is increasing. Tumor stage, hospital volume, and hospital location were the most statistically significant predictors of biopsy type. Rates of needle biopsy at high-volume hospitals suggest that appropriate utilization of this preferred diagnostic method should approach 90%.
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Affiliation(s)
- Richelle T Williams
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
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Preoperative cytological and histological diagnosis of breast lesions: A critical review. Eur J Surg Oncol 2010; 36:934-40. [PMID: 20709485 DOI: 10.1016/j.ejso.2010.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 05/20/2010] [Accepted: 06/07/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Non-operative pathology diagnoses constitute an essential part of the work-up of breast lesions. With fine needle aspiration (FNA) and core needle biopsy (CNB) both having unique advantages, there is an increasing acceptance of CNB. This paper aims to outline the scientific basis of this trend. Additionally, we provide an update on novel techniques that derive cytological specimens from CNB (i.e., touch imprint (TI) and core wash (CW) cytology) in an attempt to get the best of both worlds. METHODS In addition to using the authors' experience, we performed a search of the Medline database combining the search terms "breast cancer diagnosis", "core needle biopsy", "fine needle aspiration", "touch imprint cytology", "core wash cytology" and "complications". We defined a conclusive non-operative diagnosis as "malignant" in lesions that were malignant on follow-up and "benign" in lesions that were benign on follow-up. RESULTS CNB was more often conclusive than FNA in benign and malignant lesions in 4 prospective studies. Although the more rapid diagnoses by FNA result in less patient anxiety during diagnostic work-up, CNB allows for fairly reliable estimation of invasion, histological type, grade, and receptor expression. CW and TI cytology seem promising techniques with conclusiveness rates that are roughly comparable to that of FNA. CONCLUSIONS All new suspicious breast lesions require careful non-operative investigation by CNB. However, additional cytological assessment by FNA can still be useful as a same-day diagnosis decreases patient anxiety and facilitates surgical treatment planning. TI and CW cytology techniques are promising same-day diagnosis modalities.
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Tang J, Xie XM, Wang X, Xie ZM, He JH, Wu YP, Fan W, Fu JH, Yang MT. Radiocolloid in Combination with Methylene Dye Localization, Rather Than Wire Localization, is a Preferred Procedure for Excisional Biopsy of Nonpalpable Breast Lesions. Ann Surg Oncol 2010; 18:109-13. [DOI: 10.1245/s10434-010-1207-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Indexed: 11/18/2022]
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Zito FA, Verderio P, Simone G, Angione V, Apicella P, Bianchi S, Conde AF, Hameed O, Ibarra J, Leong A, Pennelli N, Pezzica E, Vezzosi V, Ventrella V, Pizzamiglio S, Paradiso A, Ellis I. Reproducibility in the diagnosis of needle core biopsies of non-palpable breast lesions: an international study using virtual slides published on the world-wide web. Histopathology 2010; 56:720-6. [DOI: 10.1111/j.1365-2559.2010.03548.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Certain nonmalignant lesions encountered on percutaneous breast biopsies pose dilemmas with regard to the most appropriate clinical management subsequent to needle biopsy (ie, surgical excision vs. follow-up). These lesions include columnar cell lesions, atypical ductal hyperplasia, lobular neoplasia, papillary lesions, radial scars, fibroepithelial lesions, and mucocele-like lesions. As minimally invasive diagnostic procedures are now standard it is more important than ever to be aware of the limitations of percutaneous biopsy, particularly with regard to apparently benign lesions because of the risk that the radiologically detected lesion may harbor malignant disease not represented in the biopsy specimen. This underscores the importance of radiologic-pathologic correlation. Increasingly, radiologists are adopting vacuum-assisted devices using larger gauge needles. The changing practices among radiologists are reflected in recent studies which have enriched the literature. In addition, magnetic resonance imaging is being used more frequently in breast imaging, resulting in pathologists more often encountering benign biopsies with uncertain imaging correlation. These changes prompted evaluation of the recent literature and its possible effect on management concerns. This review focuses on management issues following the diagnosis of nonmalignant lesions diagnosed on percutaneous breast biopsy and highlights imaging terms commonly used in breast radiology reports to facilitate accurate radiologic-pathologic correlation.
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Kreipe HH, Höfler H, Lebeau A, Pickartz H, Schmidt D. [Results of reference pathology in mammography screening]. DER PATHOLOGE 2009; 29 Suppl 2:178-80. [PMID: 18841364 DOI: 10.1007/s00292-008-1096-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
As a measure of quality assurance in mammography screening in Germany, obligatory double reading of histopathological specimens is currently a subject of debate. Concordance rates of more than 6000 cases gathered from several reference centres were evaluated. In accordance with several international studies, overall agreement in single and double readings in German mammography screening was approximately 95%. Concordance rates were even higher for malignancies (99%). Variations are more common in the case of lesions, the biological significance of which remains unclear (flat atypia, lobular neoplasm, papilloma). This is the result of a currently unresolvable methodological rather classification problem, as seen from studies from countries with many years of experience in training and diagnostic test series. Thus, the evidence base is currently insufficient to mandate double reading of slides.
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Affiliation(s)
- H H Kreipe
- Pathologisches Institut, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625 Hannover.
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Diagnostic Concordance in Reporting Breast Needle Core Biopsies using the B Classification—A Panel in Italy. Pathol Oncol Res 2009; 15:725-32. [DOI: 10.1007/s12253-009-9176-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 04/28/2009] [Indexed: 10/20/2022]
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35
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Prospective and Retrospective Second Reviews and Audits in Anatomic Pathology. PATHOLOGY CASE REVIEWS 2009. [DOI: 10.1097/pcr.0b013e3181a05dfe] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Jara-Lazaro AR, Tan PH. Pattern and spectrum of morphology referrals in breast pathology consultation. Pathology 2008; 40:564-72. [PMID: 18752122 DOI: 10.1080/00313020802320457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS We aimed to identify common reasons for second opinion breast pathology referrals at the Pathology Department, Singapore General Hospital, focusing on queries and diagnostic issues raised by referring clinicians and pathologists. METHODS Request forms for breast pathology consultations were retrieved from a specialist's correspondence files consisting of pathologists' referrals, and from centralised laboratory records, comprising clinician-initiated referrals. Clinical and histomorphological queries raised by the referrals were collated. RESULTS Of 299 cases evaluated, clinician-initiated referrals (n = 137, 46%) included requests for review of overall histopathology to confirm carcinoma subtype (n = 47), grade (n = 2), size (n = 4), lymphovascular invasion (n = 1) and confirm hormonal receptor and c-erbB-2 assays (n = 33). Also required were: comparison of recurrent with previous lesions (n = 8); settling discrepant diagnoses between two or more prior pathology reports (n = 4); verification of microinvasion (n = 6), in situ carcinomas (n = 6) or atypical ductal hyperplasias (n = 4); delineation of benign (n = 8) and spindle cell lesions (n = 3); to establish a breast origin of metastatic lesions (n = 5); and distinction of carcinoma from lymphoma (n = 2). Pathologist-initiated referrals (n = 162, 54%) sought arbitration between borderline proliferative lesions (n = 46) and papillary lesions (n = 34); verification of microinvasion (n = 23), stromal lesions (n = 16), and carcinoma subtype (n = 13), especially if the patient was young (n = 5); clarification of metaplastic changes (n = 4) and lobular neoplasia (n = 8); and comparison of fibroepithelial lesions (n = 11). CONCLUSIONS Clinicians sought a second opinion mainly to verify histological diagnoses and report important pathological details for staging and confirmation of hormonal receptor and c-erbB-2 status prior to therapy. Borderline breast lesions are worrisome for both clinicians and pathologists in view of implications for management.
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Guideline implementation for breast healthcare in low- and middle-income countries. Cancer 2008; 113:2257-68. [DOI: 10.1002/cncr.23840] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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MacGrogan G, Arnould L, de Mascarel I, Vincent-Salomon A, Penault-Llorca F, Lacroix-Triki M, Bibeau F, Baranzelli MC, Fridman V, Antoine M, Bécette V, Brouste V, Jacquemier J, Mathoulin-Pélissier S. Impact of immunohistochemical markers, CK5/6 and E-cadherin on diagnostic agreement in non-invasive proliferative breast lesions. Histopathology 2008; 52:689-97. [DOI: 10.1111/j.1365-2559.2008.03016.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schueller G, Schueller-Weidekamm C, Helbich TH. Accuracy of ultrasound-guided, large-core needle breast biopsy. Eur Radiol 2008; 18:1761-73. [PMID: 18414872 DOI: 10.1007/s00330-008-0955-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Revised: 01/31/2008] [Accepted: 02/23/2008] [Indexed: 11/30/2022]
Abstract
Ultrasound-guided, large-core needle biopsy (US-LCNB) of suspicious breast lesions is acknowledged as less invasive and less expensive and less time consuming than surgical biopsy, and provides a histologic diagnosis with a comparable high degree. US-LCNB has been proven to help reduce the number of unnecessary surgeries for benign disease. Its limitations, however, are false-negative results and underestimation of disease. Thus, the demand for breast teams is to carefully adhere to the principles of triple assessment and imaging-histologic correlation, and follow-up of lesions with a specific benign histology after biopsy. Also, the acceptance of guidelines and rigorous quality controls help to reliably minimize the delay in the diagnosis of breast cancer in patients with false-negative biopsies. This paper aims to summarize the equipment and methods as well as the benefits and limitations of US-LCNB. Also, guidelines of quality assessment are suggested. Finally, recent developments which may help to overcome the limitations of US-LCNB will be discussed, i.e., directional vacuum-assisted biopsy (VAB), three-dimensional (3D) US-guided biopsy, as well as the use of tissue harmonic imaging (THI) and compound imaging (CI) during biopsy.
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Affiliation(s)
- G Schueller
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Masood S. Raising the bar: a plea for standardization and quality improvement in the practice of breast pathology. Breast J 2008; 12:409-12. [PMID: 16958956 DOI: 10.1111/j.1075-122x.2006.00337.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kluttig A, Trocchi P, Heinig A, Holzhausen HJ, Taege C, Hauptmann S, Boecker W, Decker T, Loening T, Schmidt-Pokrzywniak A, Thomssen C, Lantzsch T, Buchmann J, Stang A. Reliability and validity of needle biopsy evaluation of breast-abnormalities using the B-categorization--design and objectives of the Diagnosis Optimisation Study (DIOS). BMC Cancer 2007; 7:100. [PMID: 17570833 PMCID: PMC1913923 DOI: 10.1186/1471-2407-7-100] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 06/14/2007] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The planned nationwide implementation of mammography screening 2007 in Germany will increase the occurrence of mammographically detected breast abnormalities. These abnormalities are normally evaluated by minimal invasive core biopsy. To minimize false positive and false negative histological findings, quality assurance of the pathological evaluation of the biopsies is essential. Various guidelines for quality assurance in breast cancer diagnosis recommend applying the B-classification for histopathological categorization. However, to date there are only few studies that reported results about reliability and validity of B-classification. Therefore, objectives of our study are to determine the inter- and intraobserver variability (reliability study) and construct and predictive validity (validity study) of core biopsy evaluation of breast abnormalities. This paper describes the design and objectives of the DIOS Study. METHODS/DESIGN All consecutive asymptomatic and symptomatic women with breast imaging abnormalities who are referred to the University Hospital of Halle for core breast biopsy over a period of 24 months are eligible. According to the sample size calculation we need 800 women for the study. All patients in the study population underwent clinical and radiological examination. Core biopsy is performed by stereotactic-, ultrasound- or magnetic resonance (MR) guided automated gun method or vacuum assisted method. The histopathologic agreement (intra- and interobserver) of pathologists and the histopathologic validity will be evaluated. Two reference standards are implemented, a reference pathologist and in case of suspicious or malignant findings the histopathologic result of excision biopsy. Furthermore, a self administrated questionnaire which contains questions about potential risk factors of breast cancer, is sent to the participants approximately two weeks after core biopsy. This enables us to run a case-control-analysis (woman with breast cancer histological verified after excision are defined as cases, woman without malignant breast lesions are defined as controls) to investigate the predictive values of various risk factors on breast cancer risk. CONCLUSION The analysis of reliability and validity of the histopathological evaluation of core biopsy specimens of breast abnormalities is intended to provide important information needed for a high quality in breast cancer diagnostic and for planning of treatment strategies.
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MESH Headings
- Biopsy, Needle/standards
- Breast Diseases/diagnosis
- Breast Diseases/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Calcinosis/diagnosis
- Calcinosis/pathology
- Carcinoma in Situ/diagnosis
- Carcinoma in Situ/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/pathology
- Diagnosis, Differential
- False Negative Reactions
- False Positive Reactions
- Female
- Germany
- Humans
- Immunohistochemistry
- Mammography
- Mass Screening/methods
- Observer Variation
- Reference Standards
- Reproducibility of Results
- Retrospective Studies
- Sensitivity and Specificity
- Stereotaxic Techniques
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Affiliation(s)
- Alexander Kluttig
- Clinical Epidemiology Unit, Institute of Medical Epidemiology, Biometry and Informatics, University Halle-Wittenberg, Halle (Saale), Germany
| | - Pietro Trocchi
- Clinical Epidemiology Unit, Institute of Medical Epidemiology, Biometry and Informatics, University Halle-Wittenberg, Halle (Saale), Germany
| | - Anke Heinig
- Clinic of Diagnostic Radiology, University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Christiane Taege
- Institute of Pathology, University Halle-Wittenberg, Halle (Saale), Germany
| | - Steffen Hauptmann
- Institute of Pathology, University Halle-Wittenberg, Halle (Saale), Germany
| | - Werner Boecker
- Gerhard-Domagk-Institute of Pathology, University Münster, Münster Germany
| | - Thomas Decker
- Gerhard-Domagk-Institute of Pathology, University Münster, Münster Germany
| | | | - Andrea Schmidt-Pokrzywniak
- Clinical Epidemiology Unit, Institute of Medical Epidemiology, Biometry and Informatics, University Halle-Wittenberg, Halle (Saale), Germany
| | - Christoph Thomssen
- Clinic of Gynaecology, University Halle-Wittenberg, Halle (Saale), Germany
| | - Tilmann Lantzsch
- Clinic of Gynaecology and Obsteterics, St. Elisabeth & St. Barbara Hospital, Halle (Saale), Germany
| | - Joerg Buchmann
- Institute of Pathology, Martha-Maria Hospital, Halle (Saale), Germany
| | - Andreas Stang
- Clinical Epidemiology Unit, Institute of Medical Epidemiology, Biometry and Informatics, University Halle-Wittenberg, Halle (Saale), Germany
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Andreu FJ, Sáez A, Sentís M, Rey M, Fernández S, Dinarès C, Tortajada L, Ganau S, Palomar G. Breast core biopsy reporting categories—An internal validation in a series of 3054 consecutive lesions. Breast 2007; 16:94-101. [PMID: 16982194 DOI: 10.1016/j.breast.2006.06.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Revised: 06/16/2006] [Accepted: 06/16/2006] [Indexed: 11/29/2022] Open
Abstract
We reviewed 3226 consecutive core biopsies (CBs) of 3054 mammographically detected breast lesions performed at our Centre from November 1993 to June 2003. CB diagnoses, classified according to the Non-operative Diagnosis Subgroup of the British National Health Service Breast Cancer Screening Programme (NHSBSP), were B5 (37.1%), B4 (0.5%), B3 (7.6%), B2 (50.9%) and B1 (3.9%). It was necessary to repeat the procedure in 172 cases (5.3%). The values for absolute sensitivity and specificity are 90.8% and 83.8%, respectively. The positive predictive value for categories B4 and B5 is 100%, with no false-positives. The positive predictive value for category B3 is 16.3%. The negative predictive value for B2 category is 97.2%, with a false-negative rate of 3.5%. In conclusion, this system of analysis has enabled us to confirm that our CB results surpass the minimum recommended standards proposed by the NHSBSP.
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Affiliation(s)
- Francisco Javier Andreu
- Pathology Department, UDIAT-Centre Diagnòstic Corporació Parc Taulí, Parc Taulí, s/n., 08208 Sabadell, Spain.
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Renshaw AA, Gould EW. Comparison of Disagreement and Amendment Rates by Tissue Type and Diagnosis. Am J Clin Pathol 2006. [DOI: 10.1309/dh4u0kt6qb01kr55] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sequeiros RB, Reinikainen H, Sequeiros AMB, Vaara T, Ojala R, Pääkkö E, Tervonen O. MR-guided breast biopsy and hook wire marking using a low-field (0.23 T) scanner with optical instrument tracking. Eur Radiol 2006; 17:813-9. [PMID: 17021710 DOI: 10.1007/s00330-006-0377-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Accepted: 06/19/2006] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to evaluate the technical feasibility of MR-guided percutaneous breast biopsy (LCNB) and breast hook wire marking in a low-field (0.23 T) MRI system with optical instrument tracking. MR-guided core biopsy and/or hook wire marking was performed on 13 lesions observable at MR imaging only. Seven breast LCNBs and 10 hook wire markings were performed under MR guidance on 11 patients. The diagnosis was confirmed by excision biopsy or mastectomy in 12 lesions and with histopathological and cytological diagnosis and 12-month clinical follow-up in one lesion. All lesions seen in the high-field scanner were also successfully identified and targeted in the low-field scanner. The following procedures were typically technically successful. There were difficulties due to unsatisfactory functioning of some core biopsy guns. Detailed description of low-field MR guidance and optical tracking in breast biopsies is provided. The procedure seems accurate and safe and provides means to obtain a histological diagnosis of a breast lesion only seen with MRI. The low-field biopsy system is comparable to the high-field MRI system. MR-compatible biopsy guns need to be improved.
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Wu YC, Chen DR, Kuo SJ. Personal experience of ultrasound-guided 14-gauge core biopsy of breast tumor. Eur J Surg Oncol 2006; 32:715-8. [PMID: 16769196 DOI: 10.1016/j.ejso.2006.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 04/20/2006] [Indexed: 10/24/2022] Open
Abstract
AIM This study was aimed to examine the efficacy of ultrasound-guided core needle biopsy of breast tumor and compared with the results of previous publications. METHODS From January 2001 to September 2003, 546 lesions in 513 consecutive patients with the identification of a tumor on ultrasound examination categorized belong and above C3 according to BIRADS (Breast Image Reporting and Data Systems). A minimum of three samples was taken during the biopsy process. RESULTS The patients' ages ranged from 17 to 89 years (mean, 43 years); tumors were from 5.7 to 41.6 mm in diameter (mean, 20.3 mm). There were 341 lesions with benign findings, 202 lesions with malignancy and 3 lesions with atypical ductal hyperplasia (ADH). Underestimates were found in five patients. Two patients were "ADH-DCIS (ductal carcinoma in situ) underestimate", and three patients were "DCIS-IDC (invasive ductal carcinoma) underestimate". The ADH underestimation rate was 40% (2/5) and DCIS underestimation rate was 43% (3/7). No false-positive results were observed. According to this study, the accuracy rate was 99%, sensitivity rate 97.6%, specificity rate 100%, and false-negative rate 2.4%. CONCLUSIONS Both palpable and impalpable breast lesions should be examined under image guidance and automated core biopsy is the technique of first choice. Fourteen-gauge core biopsy can provide a definitive diagnosis in 99% of solid tumors in this series.
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Affiliation(s)
- Y-C Wu
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 500, Taiwan
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Nährig J, Höfler H, Heywang-Köbrunner SH, Prat N, Hölzel D, Wünsch PH, Lebeau A. [Experiences of the Bavarian mammography screening program]. DER PATHOLOGE 2006; 27:387-91. [PMID: 16858556 DOI: 10.1007/s00292-006-0854-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Bavarian Mammography Screening Program started in April 2003. A detailed analysis of the consistency of diagnosis in the evaluation of vacuum-assisted stereotactic or core needle breast biopsies is presented. A total of 32 pathologists participated in a blinded evaluation of the biopsies. Each case was evaluated independently by two participating pathologists. A total of 1,357 cases were reviewed. The histopathological reports of the biopsies made by the two consulting pathologists were compared. The concordance rate of the first and second consulting pathologist was 93% for the B-classification. In general, the level of diagnostic agreement was very high for well defined, benign and malignant lesions. Some of the discrepancies resulted from the incorrect application of the B-classification. Discrepancies in the reports were also due to divergent interpretation of benign and "borderline" lesions. The protocol for the blinded evaluation of breast biopsies in two rounds assured a high level of quality. In conclusion, prerequisites for the success of a mammography screening program are interdisciplinary consensus conferences and audit rounds involving pathologists.
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Affiliation(s)
- J Nährig
- Institut für Allgemeine Pathologie und Pathologische Anatomie, Technische Universität, Ismaninger Strasse 22, 81675, München, Germany.
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Schnall MD, Blume J, Bluemke DA, DeAngelis GA, DeBruhl N, Harms S, Heywang-Köbrunner SH, Hylton N, Kuhl CK, Pisano ED, Causer P, Schnitt SJ, Thickman D, Stelling CB, Weatherall PT, Lehman C, Gatsonis CA. Diagnostic Architectural and Dynamic Features at Breast MR Imaging: Multicenter Study. Radiology 2006; 238:42-53. [PMID: 16373758 DOI: 10.1148/radiol.2381042117] [Citation(s) in RCA: 355] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To prospectively determine the prevalence and predictive value of three-dimensional (3D) and dynamic breast magnetic resonance (MR) imaging and contrast material kinetic features alone and as part of predictive diagnostic models. MATERIALS AND METHODS The study protocol was approved by the institutional review board or ethics committees of all participating institutions, and informed consent was obtained from all participants. Although study data collection was performed before HIPAA went into effect, standards that would be compliant with HIPAA were adhered to. Data from the International Breast MR Consortium trial 6883 were used in the analysis. Women underwent 3D (minimum spatial resolution, 0.7 x 1.4 x 3 mm; minimal temporal resolution, 4 minutes) and dynamic two-dimensional (temporal resolution, 15 seconds) MR imaging examinations. Readers rated enhancement shape, enhancement distribution, border architecture, enhancement intensity, presence of rim enhancement or internal septations, and the shape of the contrast material kinetic curve. Regression was performed for each feature individually and after adjustment for associated mammographic findings. Multivariate models were also constructed from multiple architectural and dynamic features. Areas under the receiver operating characteristic curve (Az values) were estimated for all models. RESULTS There were 995 lesions in 854 women (mean age, 53 years +/- 12 [standard deviation]; range, 18-80 years) for whom pathology data were available. The absence of enhancement was associated with an 88% negative predictive value for cancer. Qualitative characterization of the dynamic enhancement pattern was associated with an Az value of 0.66 across all lesion architectures. Focal mass margins (Az = 0.76) and signal intensity (Az = 0.70) were highly predictive imaging features. Multivariate models were constructed with an Az value of 0.880. CONCLUSION Architectural and dynamic features are important in breast MR imaging interpretation. Multivariate models involving feature assessment have a diagnostic accuracy superior to that of qualitative characterization of the dynamic enhancement pattern.
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Affiliation(s)
- Mitchell D Schnall
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.
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Carpentier E, Maruani A, Michenet P, Bonneau C, Degand P, Lebas P. [Can US-guided vacuum-assisted biopsies be an alternative to diagnostic surgery in cases of non-diagnostic core needle biopsy?]. ACTA ACUST UNITED AC 2005; 86:475-80. [PMID: 16114203 DOI: 10.1016/s0221-0363(05)81392-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess US-guided vacuum-assisted biopsies in the diagnosis of suspicious sonographic breast lesions after non-diagnostic core needle biopsies (CNB). PATIENTS AND METHODS Retrospective study of 42 females with suspicious breast lesions at US. CNB previously performed were non-diagnostic. Because of the larger sample size, vacuum-assisted biopsies were performed, instead of surgical biopsy. RESULTS Vacuum-assisted biopsies showed 32 benign lesions. Histologic examination of the CNB showed non-specific fibrous tissue in 43% of cases as opposed to 7.1% for vacuum-assisted biopsies. The latter provided a more specific diagnosis (mainly fibrocystic breast disease). From a total of 4 lesions that were suspicious at CNB, 3 were diagnosed as malignancies after vacuum-assisted biopsy and one case was a "borderline" lesion. Three additional malignant and three additional borderline lesions were diagnosed on vacuum-assisted biopsies. In 11 cases, surgical excision was performed, and all diagnoses from vacuum-assisted biopsies were confirmed at microscopy, except in one case where it was underestimated (ADH versus DCIS). CONCLUSION US-guided vacuum-assisted biopsy is a reliable technique. Because it provides more tissue than CNB, it can be an alternative to diagnostic surgery after non-diagnostic CNB. Indeed, it allows confirmation of the diagnosis and provides a more specific diagnosis of benign lesions. With regards to malignant and borderline lesions, it avoids the risk of false-negative CNB and overlooking carcinomas.
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Affiliation(s)
- E Carpentier
- Service de Radiologie, Hôpital Porte-Madeleine, CHR d'Orleans, BP 2439, 45032 Orleans 1
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Usami S, Moriya T, Kasajima A, Suzuki A, Ishida T, Sasano H, Ohuchi N. Pathological aspects of core needle biopsy for non-palpable breast lesions. Breast Cancer 2005; 12:272-8. [PMID: 16286907 DOI: 10.2325/jbcs.12.272] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recently, the incidence of non-palpable or noninvasive breast cancer has increased. Consequently, criteria for choosing procedures to obtain pathological materials had changed. Fine needle aspiration biopsy cytology (FNA) and core needle biopsy (CNB) are both reliable procedures for detecting breast cancer. However, for non-palpable lesions, the diagnostic accuracy of CNB is higher. The main limits of FNA are the high rate of insufficient sampling and inability to determine invasiveness. CNB is an established alternative to surgical biopsy, and CNB can avoid excess surgical biopsies in a large number of patients. In addition to accurate histological diagnosis, there is interest in obtaining prognostic information from CNB, especially for patients being considered for preoperative (neoadjuvant) therapy. CNB provides useful information about histologic type and grade. However, an unavoidable problem of CNB is underestimation of invasion. On the other hand, there is good concordance in particular for estrogen receptor (ER) and progesterone receptor (PR) between CNB and surgical excision. Several aspects of CNB remains controversial, such as diagnosing papillary lesions by CNB, problems regarding tumor cell displacement after CNB, and management of lobular neoplasia (LN) on CNB.
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Affiliation(s)
- Shin Usami
- Department of Pathology, Tohoku University Hospital, Aoba-ku, Sendai 980-8574, Japan
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