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Warm HL, Kandt LD, Schaumann N, Werlein C, Gronewold M, Christgen H, Hellmann M, Lafos M, Auber B, Hillemanns P, Kreipe H, Christgen M. Immunohistochemical marker profiles for the differentiation of collagenous spherulosis from adenoid cystic carcinoma of the breast. Hum Pathol 2024; 148:7-13. [PMID: 38677556 DOI: 10.1016/j.humpath.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
Collagenous spherulosis (CS) is a rare breast lesion of unknown histogenesis. Adenoid cystic carcinoma (ACC) is a rare basal-like breast carcinoma with low histological grade. CS is a benign lesion but resembles ACC. Both lesions show a similar histomorphology and feature bilineage differentiation. This study compared immunohistochemical markers in CS and ACC. We compiled n = 13 CS cases and n = 18 mammary ACCs. Fourteen marker proteins (ER, PR, HER2, GATA3, CK7, E-cadherin, CD117, CK5/14, p40, p63, SMA, CD10, calponin, P-cadherin) were evaluated by immunohistochemistry (IHC). MYB rearrangement, a common alteration in ACC, was assessed by fluorescence in situ hybridization. Patient age ranged between 40-60 years for CS lesions and 30-90 years for ACCs. 7/13 (54%) CS cases harbored a lobular carcinoma in situ (LCIS) in the luminal component. One CS/LCIS lesion occurred in a carrier of a pathogenic germline variant in CDH1/E-cadherin. MYB rearrangement was detected in 0/11 (0%) CS and 6/16 (37%) ACC cases (P = 0.054). CS was associated with expression of ER in the luminal component (P < 0.001), E-cadherin loss in the luminal component (P = 0.045), and expression of CD10 and calponin in the basal component (P < 0.001). Furthermore, CS was associated with GATA3 expression in the luminal component (12/13 [92%] versus 5/18 [27%], P < 0.001). In summary, IHC for GATA3 and E-cadherin may contribute to the differential diagnosis between CS and ACC, although these markers are not exclusively expressed in either lesion. Histologic evaluation has to take into account that CS is frequently colonized by LCIS, requiring thorough correlation of histomorphology and immunohistochemical features.
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Affiliation(s)
- Henriette L Warm
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Leonie D Kandt
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Nora Schaumann
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Christopher Werlein
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Malte Gronewold
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Henriette Christgen
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Malin Hellmann
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Marcel Lafos
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Bernd Auber
- Department of Human Genetics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Peter Hillemanns
- Clinic for Obstetrics, Gynecology and Neonatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Hans Kreipe
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Matthias Christgen
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Gwak H, Woo SS, Oh SJ, Kim JY, Shin HC, Youn HJ, Chun JW, Lee D, Kim SH. A Comparison of the Prognostic Effects of Fine Needle Aspiration and Core Needle Biopsy in Patients with Breast Cancer: A Nationwide Multicenter Prospective Registry. Cancers (Basel) 2023; 15:4638. [PMID: 37760607 PMCID: PMC10527552 DOI: 10.3390/cancers15184638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/05/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Breast core needle biopsy (CNB) is preferred over fine needle aspiration (FNA) as it has higher sensitivity and specificity and enables immunohistochemical evaluation. However, breast FNA remains widely used because of its low cost, minimally invasive nature, and quick results. Studies analyzing the effects of each test on the prognoses of patients with breast cancer are scarce and controversial, and the criteria for test selection remain unknown. (2) Methods: This study included adult female patients who underwent breast cancer surgery at 102 general hospitals. The trend of breast biopsies over time was analyzed, and the prognoses of patients with breast cancer who underwent CNB and FNA were compared. (3) Results: This study included 73,644 patients who underwent FNA (n = 8027) and CNB (n = 65,617). A multivariate Cox regression analysis showed that patients diagnosed using FNA had significantly worse overall survival (OS) and breast-cancer-specific survival (BCSS) than those diagnosed using CNB. In the subgroup analysis, patients with breast imaging reporting and data system (BI-RADS) 5 lesions, palpable tumors, or centrally located tumors had significantly worse OS and BCSS with FNA than with CNB. (4) Conclusions: CNB should be performed preferentially instead of FNA in patients with BI-RADS 5 lesions and nonpalpable or centrally located tumors.
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Affiliation(s)
- Hongki Gwak
- Division of Thyroid and Breast Surgical Oncology, Department of Surgery, Hwahong Hospital, Suwon 16630, Republic of Korea;
| | - Sang Seok Woo
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (S.S.W.)
| | - Se Jeong Oh
- Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jee Ye Kim
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul 03186, Republic of Korea
| | - Hee-Chul Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Republic of Korea
| | - Hyun Jo Youn
- Department of Surgery, Jeonbuk National University Medical School, Jeonju-si 54907, Republic of Korea;
| | - Jung Whan Chun
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 03080, Republic of Korea
| | - Dasom Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (S.S.W.)
| | - Seong Hwan Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (S.S.W.)
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Lobular Breast Cancer: Histomorphology and Different Concepts of a Special Spectrum of Tumors. Cancers (Basel) 2021; 13:cancers13153695. [PMID: 34359596 PMCID: PMC8345067 DOI: 10.3390/cancers13153695] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Invasive lobular breast cancer (ILC) is a special type of breast cancer (BC) that was first described in 1941. The diagnosis of ILC is made by microscopy of tumor specimens, which reveals a distinct morphology. This review recapitulates the developments in the microscopic assessment of ILC from 1941 until today. We discuss different concepts of ILC, provide an overview on ILC variants, and highlight advances which have contributed to a better understanding of ILC as a special histologic spectrum of tumors. Abstract Invasive lobular breast cancer (ILC) is the most common special histological type of breast cancer (BC). This review recapitulates developments in the histomorphologic assessment of ILC from its beginnings with the seminal work of Foote and Stewart, which was published in 1941, until today. We discuss different concepts of ILC and their implications. These concepts include (i) BC arising from mammary lobules, (ii) BC growing in dissociated cells and single files, and (iii) BC defined as a morpho-molecular spectrum of tumors with distinct histological and molecular characteristics related to impaired cell adhesion. This review also provides a comprehensive overview of ILC variants, their histomorphology, and differential diagnosis. Furthermore, this review highlights recent advances which have contributed to a better understanding of the histomorphology of ILC, such as the role of the basal lamina component laminin, the molecular specificities of triple-negative ILC, and E-cadherin to P-cadherin expression switching as the molecular determinant of tubular elements in CDH1-deficient ILC. Last but not least, we provide a detailed account of the tumor microenvironment in ILC, including tumor infiltrating lymphocyte (TIL) levels, which are comparatively low in ILC compared to other BCs, but correlate with clinical outcome. The distinct histomorphology of ILC clearly reflects a special tumor biology. In the clinic, special treatment strategies have been established for triple-negative, HER2-positive, and ER-positive BC. Treatment specialization for patients diagnosed with ILC is just in its beginnings. Accordingly, ILC deserves greater attention as a special tumor entity in BC diagnostics, patient care, and cancer research.
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Apparent diffusion coefficient values in borderline breast lesions upgraded and not upgraded at definitive histopathological examination after surgical excision. Pol J Radiol 2021; 86:e255-e261. [PMID: 34093923 PMCID: PMC8147718 DOI: 10.5114/pjr.2021.105857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 05/13/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose The study aims were to evaluate if the apparent diffusion coefficient (ADC) value could distinguish between breast lesions classified as B3 at core needle biopsy (CNB) that show or do not show atypia or malignancy at definitive histopathological examination (DHE) after surgical excision. Material and methods From January 2013 to December 2017, 141 patients with a B3 breast lesion underwent magnetic resonance imaging and were included in the study. The ADC value was assessed drawing a ROI outlining the entire lesion, evaluating the mean (ADCmean) and minimum ADC values (ADCmin). Results Both ADCmean and ADCmin values showed a statistically significant difference between B3 lesions without and with malignancy or, for B3a lesions, atypia at DHE. They both showed a statistically significant difference also between B3a lesions without or with atypia or malignancy at DHE, but only ADCmin (not ADCmean) showed statistically significant difference between B3b lesions without or with malignancy at DHE. Conclusions The ADC value could help distinguish between B3a lesions without or with atypia/malignancy at DHE after surgical excision and between B3b lesions without or with malignancy at DHE. Therefore, it could be used to help guide the diagnostic-therapeutic pathway of these lesions, particularly of B3a lesions.
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Marabi M, Aphivatanasiri C, Jamidi SK, Wang C, Li JJ, Hung EH, Poon IK, Tsang JY, Tse GM. The International Academy of Cytology Yokohama System for Reporting Breast Cytopathology showed improved diagnostic accuracy. Cancer Cytopathol 2021; 129:852-864. [PMID: 34029453 DOI: 10.1002/cncy.22451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of the International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology is to improve cytology practice. This study assessed cytologic diagnoses made with the system and its efficacy when it was applied by pathologists with different levels of experience. METHODS In all, 1080 cases of breast fine-needle aspiration biopsy (FNAB) over a period of 16 years were reviewed and reclassified with the system. The category distribution and the diagnostic performance were compared with the original diagnoses. The concordance rates for diagnoses from pathologists with different levels of experience were also determined. RESULTS The distribution of cytologic diagnoses made with the system was as follows: 11.7% were insufficient, 56.6% were benign, 20.1% were atypical, 6.1% were suspicious for malignancy, and 5.6% were malignant. The rates for the insufficient and atypical categories were lower than the original diagnosis rates (13.1% and 23.8%, respectively). Overall, 120 cases (11.1%) were recategorized. Among those recategorized as benign, suspicious, or malignant with follow-up data, 96.7% were correctly reclassified. A significant improvement in diagnostic performance was found with the system (P < .001). Such improvement was also seen in problematic breast lesions, including fibroepithelial lesions, papillary lesions, and low-grade carcinomas. Pathologists with intermediate experience showed a higher concordance with an expert pathologist in the diagnoses than those with short experience (κ, 0.838 vs 0.634). CONCLUSIONS The system effectively categorized the diagnoses, and the diagnostic performance of FNAB reporting was improved. The structured reporting also enhanced the reproducibility of reporting by pathologists with intermediate experience and, to some extent, those with short experience.
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Affiliation(s)
- Monalyn Marabi
- Department of Pathology, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | | | | | - Chao Wang
- Department of Pathology, Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Joshua J Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Esther H Hung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Ivan K Poon
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Julia Y Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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6
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Motoda N, Ohashi R, Makino T, Manabe E, Makita M, Naito Z. Utility of duct-washing cytology for detection of early breast cancer in patients with pathological nipple discharge: A comparative study with fine-needle aspiration cytology. Diagn Cytopathol 2020; 48:1273-1281. [PMID: 32767835 DOI: 10.1002/dc.24572] [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: 12/13/2019] [Revised: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pathological nipple discharge (PND) is a relatively common symptom of breast cancer affecting the nipple. Mammary ductscopy (MD) allows direct visualization of the ductal lumen and collection of a cytological specimen using duct-washing cytology (DWC). Herein, we clarified the diagnostic efficacy of DWC for the detection of breast cancers with PND, compared with fine-needle aspiration cytology (FNAC). METHODS We retrospectively examined 48 patients with PND who underwent DWC by MD (ductosccopy group; histologically determined by intraductal biopsy [IDB] or surgical specimen). The results of sensitivity and specificity of DWC were compared with that of FNAC (conventional group; histologically determined by core needle biopsy). Clinicopathological factors were compared between the ductoscopy and the conventional groups. RESULTS Of eight histologically malignant cases in the ductoscopy group, one case was cytologically judged as malignant and three as indeterminate. Sensitivity and specificity of DWC were 50.0% and 82.5%, respectively. Malignant cases were mostly solid papillary carcinomas (SPCs), and benign cases were intraductal papillomas (IDPs). In the conventional group, sensitivity and specificity of FNAC were 88.0% and 38.2%, respectively, and malignant cases were mainly invasive carcinomas of no special type. Tumors in the ductocsopy group had more favorable prognostic features than those in the conventional group. CONCLUSION DWC has limited diagnostic value due to the high incidence of SPC, whose cytological features are indistinguishable from IDP. As DWC alone may be unreliable, comprehensive examination with IDB and MD findings is recommended.
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Affiliation(s)
- Norio Motoda
- Department of Diagnostic Pathology, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Ryuji Ohashi
- Department of Diagnostic Pathology, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Kanagawa, Japan.,Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Takahiro Makino
- Department of Diagnostic Pathology, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Eriko Manabe
- Department of Breast Surgery, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Masujiro Makita
- Department of Breast Surgery, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Zenya Naito
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
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7
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La Forgia D, Fausto A, Gatta G, Di Grezia G, Faggian A, Fanizzi A, Cutrignelli D, Dentamaro R, Didonna V, Lorusso V, Massafra R, Tangaro S, Mazzei MA. Elite VABB 13G: A New Ultrasound-Guided Wireless Biopsy System for Breast Lesions. Technical Characteristics and Comparison with Respect to Traditional Core-Biopsy 14-16G Systems. Diagnostics (Basel) 2020; 10:diagnostics10050291. [PMID: 32397505 PMCID: PMC7277965 DOI: 10.3390/diagnostics10050291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
The typification of breast lumps with fine-needle biopsies is often affected by inconclusive results that extend diagnostic time. Many breast centers have progressively substituted cytology with micro-histology. The aim of this study is to assess the performance of a 13G-needle biopsy using cable-free vacuum-assisted breast biopsy (VABB) technology. Two of our operators carried out 200 micro-histological biopsies using the Elite 13G-needle VABB and 1314 14–16G-needle core biopsies (CBs) on BI-RADS 3, 4, and 5 lesions. Thirty-one of the procedures were repeated following CB, eighteen following cytological biopsy, and three after undergoing both procedures. The VABB Elite procedure showed high diagnostic performance with an accuracy of 94.00%, a sensitivity of 92.30%, and a specificity of 100%, while the diagnostic underestimation was 11.00%, all significantly comparable to of the CB procedure. The VABB Elite 13G system has been shown to be a simple, rapid, reliable, and well-tolerated biopsy procedure, without any significant complications and with a diagnostic performance comparable to traditional CB procedures. The histological class change in an extremely high number of samples would suggest the use of this procedure as a second-line biopsy for suspect cases or those with indeterminate cyto-histological results.
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Affiliation(s)
- Daniele La Forgia
- Radiodiagnostica Senologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (D.L.F.); (R.D.)
| | - Alfonso Fausto
- Dipartimento di Diagnostica per Immagini, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100 Siena, Italy; (A.F.); (M.A.M.)
| | - Gianluca Gatta
- Dipartimento Medicina di Precisione, Università degli Studi della Campania Luigi Vanvitelli, Piazza L. Miraglia 2, 80138 Napoli, Italy;
| | - Graziella Di Grezia
- Dipartimento dei Servizi—Diagnostica per Immagini, Ospedale “G. Criscuoli”, Via Quadrivio, 83054 Avellino, Italy;
| | - Angela Faggian
- UOC Diagnostica per Immagini, Azienda Ospedaliera San Pio, Via dell’Angelo 1, 82100 Benevento, Italy;
| | - Annarita Fanizzi
- Oncologia Medica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
- Correspondence: ; Tel.: +39-080-5555111
| | - Daniela Cutrignelli
- Chirurgia Plastica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
| | - Rosalba Dentamaro
- Radiodiagnostica Senologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (D.L.F.); (R.D.)
| | - Vittorio Didonna
- Fisica Medica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (V.D.); (R.M.)
| | - Vito Lorusso
- Oncologia Medica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
| | - Raffaella Massafra
- Fisica Medica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (V.D.); (R.M.)
| | - Sabina Tangaro
- Dipartimento di Scienze del Suolo, della Pianta e degli Alimenti, Università degli Studi di Bari ‘Aldo Moro’, 70125 Bari, Italy;
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Via Giovanni Amendola, 165/a, 70126 Bari, Italy
| | - Maria Antonietta Mazzei
- Dipartimento di Diagnostica per Immagini, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100 Siena, Italy; (A.F.); (M.A.M.)
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Sustova P, Klijanienko J. Value of combined use of fine‐needle aspiration and core needle biopsy in palpable breast tumors performed by pathologist: Institut Curie experience. Diagn Cytopathol 2019; 48:71-77. [DOI: 10.1002/dc.24311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/06/2019] [Accepted: 08/26/2019] [Indexed: 12/15/2022]
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Schaumann N, Raap M, Hinze L, Rieger L, Schürch CM, Antonopoulos W, Avril S, Krech T, Dämmrich M, Kayser G, Puls F, Länger F, Tinguely M, Kreipe H, Christgen M. Lobular neoplasia and invasive lobular breast cancer: Inter-observer agreement for histological grading and subclassification. Pathol Res Pract 2019; 215:152611. [PMID: 31551174 DOI: 10.1016/j.prp.2019.152611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 12/01/2022]
Abstract
Lobular neoplasia (LN), invasive lobular breast cancer (ILBC) and related pleomorphic variants represent a distinct group of neoplastic mammary gland lesions. This study assessed the inter-observer agreement of histological grading in a series of ILBC and LN. 54 cases (36x ILBC, 18x LN) were evaluated by 17 observers. 3978 classification calls on various histological features, including nuclear grade, proliferative activity (Ki67 immunohistochemistry, categorical scoring), histological grade and pleomorphism were obtained. Pairwise Cohen's kappa values were calculated and compared between various features and different observer subsets with variable histomorphological experience. In ILBC, pairwise inter-observer agreement for histological grade ranged from poor to almost perfect concordance and was higher in advanced and experienced histopathologists compared with beginners (P < 0.001). Agreement for proliferation (Ki67) ranged from slight to almost perfect concordance and was also higher in advanced and experienced histopathologists (P < 0.001). Considering different features, agreement for proliferation (Ki67) was superior to agreement for histological grade and nuclear grade, even among advanced and experienced histopathologists (P < 0.001). In LN, agreement for B-classification ranged from poor to almost perfect concordance and was higher in advanced and experienced histopathologists (P < 0.001). Considering different features, agreement for proliferation (Ki67 in LN) was superior to subclassification agreement based on conventional features, such as acinar distention and nuclear grade (P < 0.001). In summary, pairwise inter-observer concordance of histological grading of ILBC and LN is dependent on histomorphological experience. Assessment of proliferation by Ki67 immunohistochemistry is associated with favorable inter-observer agreement and can improve histological grading of ILBC as well as LN.
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Affiliation(s)
- Nora Schaumann
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Mieke Raap
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Laura Hinze
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Luisa Rieger
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Christian M Schürch
- Institute of Pathology, University of Bern, Murtenstr. 31, 3008 Bern, Switzerland
| | - Wiebke Antonopoulos
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Stefanie Avril
- Department of Pathology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 10900 Euclid Ave., Cleveland, OH 44106-7288, USA
| | - Till Krech
- Institute of Pathology, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Maximilian Dämmrich
- Gemeinschaftspraxis für Pathologie, Alte Bahnhofstr. 1, 97422 Schweinfurt, Germany
| | - Gian Kayser
- Institute of Surgical Pathology, University Hospital Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 115a, 79106 Freiburg, Germany
| | - Florian Puls
- Department of Pathology and Genetics, University of Gothenburg, Gula Stråket 8, 413 46 Göteborg, Sweden
| | - Florian Länger
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Marianne Tinguely
- Institute of Pathology Enge, Hardturmstrasse 133, 8005 Zürich, Switzerland
| | - Hans Kreipe
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Matthias Christgen
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Bednarova I, Londero V, Linda A, Girometti R, Lorenzon M, Bednarova S, Zuiani C. Do clinical and radiologic features help predict malignancy of B3 breast lesions without epithelial atypia (B3a)? Radiol Med 2018; 123:809-817. [PMID: 29974332 DOI: 10.1007/s11547-018-0914-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To evaluate excision histology outcome of B3a lesions diagnosed at imaging-guided core biopsy and assess whether clinical and radiologic features may predict upgrade to malignancy. METHODS A total of 153 B3a lesions (74 papillomas, 51 radial scars and 28 fibro-epithelial lesions) that underwent surgical excision were assessed. PPV for malignancy in all B3a lesions and specific for each sub-category was evaluated. Multivariate analysis was conducted to identify association between clinical (age, family or personal history of breast cancer, symptoms), diagnostic findings (imaging modality, lesion size, final BI-RADS category) and final excision outcome. RESULTS Eleven (7%) of 153 B3a lesions were upgraded to malignancy. All carcinomas diagnosed on excision were non-high grade DCIS. Following features were significantly associated with malignancy: lesions identified only on mammography (3/21; 14%), both mammography and ultrasound (7/44; 16%), lesion size > 10 mm (10/74; 13.5%) and BI-RADS category 4-5 (8/29; 27.6%). The absence of residual microcalcification after biopsy was associated with decreased risk for malignancy (15/16[93.7%]; p = 0.0297). Lesion size > 10 mm (OR = 9.3832; 95%; p = 0.0398) and BI-RADS category 4-5 (OR = 12.6004; 95%; p = 0.0006) were found to be independent predictors of upgrade to malignancy. CONCLUSIONS B3a lesions are associated with low risk of malignancy at excision. Lesion size > 10 mm and BI-RADS 4-5 category may represent useful predictors of upgrade to malignancy.
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Affiliation(s)
- Iliana Bednarova
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy.
| | - Viviana Londero
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy
| | - Anna Linda
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy
| | - Rossano Girometti
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy
| | - Michele Lorenzon
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy
| | - Sandra Bednarova
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy
| | - Chiara Zuiani
- Department of Medical Area, Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria, 'S. Maria della Misericordia, 33100, Udine, Italy
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11
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Łukasiewicz E, Ziemiecka A, Jakubowski W, Vojinovic J, Bogucevska M, Dobruch-Sobczak K. Fine-needle versus core-needle biopsy - which one to choose in preoperative assessment of focal lesions in the breasts? Literature review. J Ultrason 2017; 17:267-274. [PMID: 29375902 PMCID: PMC5769667 DOI: 10.15557/jou.2017.0039] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/10/2017] [Accepted: 09/14/2017] [Indexed: 11/22/2022] Open
Abstract
Aim The aim of the study was to review two techniques that can be used to verify focal lesions in the breasts: fine-needle aspiration biopsy and core-needle biopsy. Material and methods Fifty-five articles (original papers and reviews), half of them published within the past 5 years, were included in the analysis. The authors also took their own experience into account. Results Pre-operative assessment of focal lesions in the breasts is crucial in the planning of further therapeutic management. The role of fine-needle aspiration biopsy has been reduced lately due to its low sensitivity and specificity as well as a high rate of non-diagnostic, suspicious and false negative results. This method does not enable one to differentiate between in situ and invasive disease. Currently, fine-needle biopsy is recommended for cystic lesions, suspected of being recurrences in the chest wall, and lymph node metastases. Core-needle biopsy is the basic diagnostic method of breast lesions. According to the recommendations of the Polish Ultrasound Society and American College of Radiology, BIRADS 4 and 5 lesions should be evaluated histopathologically. Core-needle biopsy makes it possible to establish a final diagnosis more frequently than fine-needle biopsy, both in the case of benign and malignant lesions. It delivers more information about the nature of a tumor (mutation of HER-2, estrogen and progesterone receptors and Ki-67 index). Its limitations include: underestimation of invasion and failure to recognize the components of ductal carcinoma in situ in papillary and atypical lesions. Single fine-needle aspiration biopsy is inexpensive, but when considering the cost of further diagnosis due to non-diagnostic, suspicious and atypical results, this method generates high additional costs. Conclusions Microscopic verification of focal breast lesions is crucial for further therapeutic decisions. It has been proven that histopathological verification is more accurate and has more advantages than cytological assessment.
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Affiliation(s)
- Ewa Łukasiewicz
- Department of Medical Imaging, Mazovia Brodnowski Hospital, Warsaw, Poland
| | - Agnieszka Ziemiecka
- Department of Ultrasonography and Mammography, Mazovia Brodnowski Hospital, Warsaw, Poland
| | - Wiesław Jakubowski
- Department of Ultrasonography and Mammography, Mazovia Brodnowski Hospital, Warsaw, Poland
| | - Jelena Vojinovic
- Department of Pediatric Rheumatology, Clinical Center, Faculty of Medicine, University of Nis, Serbia
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12
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Absence of epithelial atypia in B3-lesions of the breast is associated with decreased risk for malignancy. Breast 2017; 31:144-149. [DOI: 10.1016/j.breast.2016.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 11/15/2022] Open
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13
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ADVANTAGE OF CORE NEEDLE BIOPSY OVER FINE NEEDLE ASPIRATION CYTOLOGY IN PALPABLE BREAST LUMPS. ACTA ACUST UNITED AC 2016. [DOI: 10.14260/jemds/2016/1085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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14
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Joudeh AA, Shareef SQ, Al-Abbadi MA. Fine-Needle Aspiration Followed by Core-Needle Biopsy in the Same Setting: Modifying Our Approach. Acta Cytol 2016; 60:1-13. [PMID: 26963594 DOI: 10.1159/000444386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/29/2016] [Indexed: 01/01/2023]
Abstract
Fine-needle aspiration biopsy (FNAB) is a well-established initial diagnostic tool. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis. Consequently, patients have to undergo another diagnostic procedure. The second procedure is either repeat FNAB, core-needle or open biopsy, and can be inconvenient and costly. In some centers, the FNAB is immediately followed by core-needle biopsy (CNB) in the same setting after assuring adequacy on the initial FNAB utilizing rapid on-site specimen evaluation (ROSE). It is argued that implementing such an approach will eventually have additional critical advantages that include the following: (a) it is more convenient to patients to have both procedures in one visit, (b) the tissue procured by both procedures will be more adequate, enabling cytopathologists to reach an accurate diagnosis, and (c) it is ultimately a cost-effective approach if we take into consideration the avoidance of a potential second more invasive diagnostic procedure. Since we are living in an era of patient-centered medicine coupled with cost-cutting strategies, we present here a brief review of the topic with analysis of this alternative approach, review of the pertinent literature and shed light on a few scenarios that justify this approach.
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Affiliation(s)
- Amani A Joudeh
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
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15
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Onur GO, Tarcan E, Onur A, Can H, Atahan MK, Yigit SC, Cakalagaoglu F. Comparison between Radiological and Invasive Diagnostic Modalities in Diagnosis of Breast Cancer. Asian Pac J Cancer Prev 2016; 16:4323-8. [PMID: 26028093 DOI: 10.7314/apjcp.2015.16.10.4323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cause of deaths of cancer in women. Nowadays, following completion of imaging methods, mainly fine needle aspiration biopsy (FNAB) and core biopsy methods have been used for establishing cytopathological diagnosis although discussions regarding superiority continue. MATERIALS AND METHODS Those with a complaint of "mass in breast" along with those diagnosed to have a mass as a result of routine physical examination among all patients applying to our clinic between 01.01.2009 and 31.12.2011 were retrospectively assessed. Totals of 146 and 64 patients with complete radiological observation who had undergone FNAB and core biopsies, respectively, were evaluated. Postoperative pathological results of patients of both groups receiving surgery were also taken into consideration. All results were compared in terms of false positivity/negativity, sensitivity/specifity, surgery types and distribution of postoperative results with regard to diagnoses along with those of malignant/benign masses with regard to quadrants determined. RESULTS Diagnostic malignancy power of mammographic BIRADS classification was 87.3%. However, the value was 75% in the core biopsy group. Sensitivity and specifity following comparison of FNAB and postoperative pathology results of those receiving surgery were 85.4% and 92.9% while they were 93.5% and 100% in the core biopsy group. Diagnostic malignancy power, calculated by determining AUC in ROC analysis, of FNAB was 89.1% while that of core biopsy was 96.7%. CONCLUSIONS It was shown that core biopsy is superior to FNAB in terms of sensitivity, specificity and accurate histopathological classification. However; quick, cheap and basic diagnosis by means of FNAB should not be ignored. Sensitivity of FNAB is rather high in experienced hands and furthermore it would be expected to be lower than with core biopsy.
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MOSCHETTA M, TELEGRAFO M, CARLUCCIO D, JABLONSKA J, RELLA L, SERIO G, CARROZZO M, IANORA ASTABILE, ANGELELLI G. Comparison between fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) in the diagnosis of breast lesions. G Chir 2014; 35:171-176. [PMID: 25174291 PMCID: PMC4321523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To compare the diagnostic accuracy of fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) in patients with USdetected breast lesions. PATIENTS AND METHODS Between September 2011 and May 2013, 3469 consecutive breast US examinations were performed. 400 breast nodules were detected in 398 patients. 210 FNACs and 190 CNBs were performed. 183 out of 400 (46%) lesions were surgically removed within 30 days form diagnosis; in the remaining cases, a six month follow up US examination was performed. Sensitivity, specificity, diagnostic accuracy, positive predictive (PPV) and negative predictive (NPV) values were calculated for FNAC and CNB. RESULTS 174 out of 400 (43%) malignant lesions were found while the remaining 226 resulted to be benign lesions. 166 out of 210 (79%) FNACs and 154 out of 190 (81%) CNBs provided diagnostic specimens. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 97%, 94%, 95%, 91% and 98% were found for FNAC, and values of 92%, 82%, 89%, 92% and 82% were obtained for CNB. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 97%, 96%, 96%, 97% and 96% were found for FNAC, and values of 97%, 96%, 96%, 97% and 96% were obtained for CNB. CONCLUSION FNAC and CNB provide similar values of diagnostic accuracy.
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17
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Is Mode of Presentation of B3 Breast Core Biopsies (Screen-Detected or Symptomatic) a Distinguishing Factor in the Final Histopathologic Result or Risk of Diagnosis of Malignancy? World J Surg 2013; 37:2607-12. [DOI: 10.1007/s00268-013-2191-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Rakha EA, Shaaban AM, Haider SA, Jenkins J, Menon S, Johnson C, Yamaguchi R, Murphy A, Liston J, Cornford E, Hamilton L, James J, Ellis IO, Lee AHS. Outcome of pure mucocele-like lesions diagnosed on breast core biopsy. Histopathology 2013; 62:894-8. [DOI: 10.1111/his.12081] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/04/2012] [Accepted: 12/04/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Emad A Rakha
- Department of Histopathology; Nottingham University; Nottingham; UK
| | - Abeer M Shaaban
- Department of Histopathology and Molecular Pathology; St James's University Hospital; Leeds; UK
| | - Syeda Asma Haider
- Department of Histopathology; Leicester University Hospitals NHS Trust; Leicester; UK
| | - Jacquie Jenkins
- East Midlands Breast Screening Programme Quality Assurance Reference Centre; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Sindhu Menon
- Department of Histopathology; Derby Hospitals NHS Foundation Trust; Derby; UK
| | - Christopher Johnson
- Department of Histopathology; Leicester University Hospitals NHS Trust; Leicester; UK
| | - Rin Yamaguchi
- Department of Pathology; Kurume University Medical Centre; Kurume; Japan
| | - Alison Murphy
- East Midlands Breast Screening Programme Quality Assurance Reference Centre; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Joyce Liston
- Leeds/Wakefield Breast Screening Service; Leeds; UK
| | - Eleanor Cornford
- Breast Unit; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Lisa Hamilton
- Breast Unit; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Jonathan James
- Breast Unit; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - Ian O Ellis
- Department of Histopathology; Nottingham University; Nottingham; UK
| | - Andrew H S Lee
- Department of Histopathology; Nottingham University; Nottingham; UK
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19
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Georgieva RD, Obdeijn IM, Jager A, Hooning MJ, Tilanus-Linthorst MMA, van Deurzen CHM. Breast fine-needle aspiration cytology performance in the high-risk screening population: a study of BRCA1/BRCA2 mutation carriers. Cancer Cytopathol 2013; 121:561-7. [PMID: 23720450 DOI: 10.1002/cncy.21308] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/24/2013] [Accepted: 04/02/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND The diagnosis of breast lesions is usually confirmed by fine-needle aspiration cytology (FNAC) or histological biopsy. Although there is increasing literature regarding the advantages and limitations of both modalities, there is no literature regarding the accuracy of these modalities for diagnosing breast lesions in high-risk patients, who usually have lesions detected by screening. The objective of the current study was to evaluate diagnostic performance indices of FNAC in breast cancer susceptibility gene (BRCA) mutation carriers. METHODS BRCA1/BRCA2 mutation carriers who underwent FNAC were selected from the database of the Rotterdam Family Cancer Clinic. FNAC accuracy parameters were calculated by taking the outcome of a subsequent histological diagnosis or clinical follow-up as reference standard. RESULTS In total, 320 FNACs were obtained, and FNAC examination was followed by histological examination in 150 patients. The rate of insufficient material was 25.6%. Sensitivity was 92.3%, specificity 96.3%. The false-positive rate was 3.7%, the false-negative rate was 7.7%, and accuracy was 94.7%. A substantial proportion of patients (35%) with malignant FNAC results underwent histological biopsy upfront surgical resection. Small lesion size (≤ 1 cm) and nonpalpability of the breast lesion were associated with decreased FNAC accuracy. In 113 patients who had a benign FNAC outcome without histological follow-up, no malignancies were detected during clinical or radiologic surveillance (median follow-up 84 months). CONCLUSIONS There is a role for FNAC in diagnosing breast lesions of BRCA1/BRCA2 mutation carriers, ie, to confirm a radiological (probably) benign lesion. However, despite the high overall sensitivity of FNAC, the authors recommend histological biopsy as the preferred diagnostic method for high-risk patients who have small or nonpalpable lesions.
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Affiliation(s)
- Radka D Georgieva
- Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
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20
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Schmidt RL, Factor RE, Witt BL, Layfield LJ. Quality Appraisal of Diagnostic Accuracy Studies in Fine-Needle Aspiration Cytology: A Survey of Risk of Bias and Comparability. Arch Pathol Lab Med 2013; 137:566-575. [DOI: 10.5858/arpa.2012-0199-ra] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Context.—The quality of diagnostic accuracy studies is determined by 2 key factors: risk of bias and comparability. Bias can distort accuracy estimates and poor reporting impairs comparability. While diagnostic accuracy studies for fine-needle aspiration cytology (FNAC) are frequently published, the methodologic issues associated with this body of literature have never been reviewed.Objective.—To assess the quality of design and reporting of diagnostic test accuracy studies in FNAC.Data Sources.—Diagnostic accuracy studies were identified by a Medline (US National Library of Medicine) search. Sixty-four FNAC diagnostic test accuracy studies were randomly selected for structured review with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) survey. Studies were divided between 2 time periods: 2000-2001 and 2009-2011.Conclusions.—Diagnostic test accuracy studies of FNAC suffer from numerous deficiencies in study design, which negatively affect the reliability of accuracy estimates.
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Affiliation(s)
- Robert L. Schmidt
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
| | - Rachel E. Factor
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
| | - Benjamin L. Witt
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
| | - Lester J. Layfield
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
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21
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Kim IS, Song YM, Lee B, Hwang SJ. Human mesenchymal stromal cells are mechanosensitive to vibration stimuli. J Dent Res 2012; 91:1135-40. [PMID: 23086742 DOI: 10.1177/0022034512465291] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Low-magnitude high-frequency (LMHF) vibrations have the ability to stimulate bone formation and reduce bone loss. However, the anabolic mechanisms that are mediated by vibration in human bone cells at the cellular level remain unclear. We hypothesized that human mesenchymal stromal cells (hMSCs) display direct osteoblastic responses to LMHF vibration signals. Daily exposure to vibrations increased the proliferation of hMSCs, with the highest efficiency occurring at a peak acceleration of 0.3 g and vibrations at 30 to 40 Hz. Specifically, these conditions promoted osteoblast differentiation through an increase in alkaline phosphatase activity and in vitro matrix mineralization. The effect of vibration on the expression of osteogenesis-related factors differed depending on culture method. hMSCs that underwent vibration in a monolayer culture did not exhibit any changes in the expressions of these genes, while cells in three-dimensional culture showed increased expression of type I collagen, osteoprotegerin, or VEGF, and VEGF induction appeared in 2 different hMSC lines. These results are among the first to demonstrate a dose-response effect upon LMHF stimulation, thereby demonstrating that hMSCs are mechanosensitive to LMHF vibration signals such that they could facilitate the osteogenic process.
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Affiliation(s)
- I S Kim
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
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22
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Brancato B, Crocetti E, Bianchi S, Catarzi S, Risso GG, Bulgaresi P, Piscioli F, Scialpi M, Ciatto S, Houssami N. Accuracy of needle biopsy of breast lesions visible on ultrasound: Audit of fine needle versus core needle biopsy in 3233 consecutive samplings with ascertained outcomes. Breast 2012; 21:449-54. [DOI: 10.1016/j.breast.2011.10.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 08/25/2011] [Accepted: 10/26/2011] [Indexed: 11/28/2022] Open
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Pagni F, Bosisio FM, Salvioni D, Colombo P, Leone BE, Di Bella C. Application of the British National Health Service Breast Cancer Screening Programme classification in 226 breast core needle biopsies: correlation with resected specimens. Ann Diagn Pathol 2011; 16:112-8. [PMID: 22056037 DOI: 10.1016/j.anndiagpath.2011.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 08/08/2011] [Accepted: 08/08/2011] [Indexed: 10/15/2022]
Abstract
A retrospective study correlating the diagnosis made on core needle breast biopsy (CNB) with the diagnosis made on the final surgical specimen was done using the British National Health Service Breast Cancer Screening Programme (NHSBSP) classification for CNB on 226 patients during a period of 15 months. Statistical analysis was used to evaluate sensitivity, specificity, and positive and negative predictive values of the NHSBSP diagnostic categories. Cohen κ was used to evaluate the agreement between the diagnosis on CNB and the final pathologic diagnosis in "clinically positive cases." Finally, a comparative analysis between the CNB method and fine needle aspiration biopsy was made. The distribution of our cases for each diagnostic category reflects the literature guidelines, with minor differences in the B2 and B4 groups. Statistical data about the patients' follow-up revealed a small number of false-negative cases in the B1 and B2 categories and no false-positive cases in the B4 and B5 groups. Uncertain malignant lesions (B3 category) were divided into 3 major areas (papillary lesions, fibroepithelial proliferations with cellular stroma, and intraepithelial atypical lesions such as ductal intraepithelial neoplasia grade 1/lobular intraepithelial neoplasia grade 1). Of the 29 patients in the B3 category, 26 underwent surgery. Cohen κ analysis showed a strong statistical correlation (κ = 0.77; Z = 4.3; significance >1.96; α = .05) between CNB diagnosis and surgical pathology final results in the subgroup of high-risk patients (diagnosis, ≥ductal intraepithelial neoplasia grade 1 on CNB). Global diagnostic power of CNB in all 226 cases revealed high sensitivity (88.3%) and slightly lower specificity (72.8%). In 42 "doubtful" cases, synchronous fine needle aspiration biopsy and CNB were performed, showing a complementary role in the diagnostic phase of breast lesions. Core needle breast biopsy represents the criterion standard method in the diagnostic phase of many breast tumors; the NHSBSP classification is a useful reporting system that provides a good standardization of the pathologic diagnosis and provides a clear guideline for the correct management of the patient.
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Affiliation(s)
- Fabio Pagni
- Department of Pathology, Azienda Ospedaliera Ospedale di Vimercate-Desio, Italy.
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Verenhitach BD, Elias S, Patrocínio AC, Nazário ACP, Waizberg A. Evaluation of the clinical efficacy of minimally invasive procedures for breast cancer screening at a teaching hospital. J Clin Pathol 2011; 64:858-61. [PMID: 21666140 DOI: 10.1136/jclinpath-2011-200057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To assess the clinical efficacy of diagnostic procedures for breast cancer at a teaching hospital using internal auditing tools and quality control measures. METHODS A retrospective assessment of 500 patients who underwent core needle biopsy (wide-bore needle biopsy; WBN) of palpable or non-palpable breast nodes that were submitted for at least one cytological examination (fine needle aspiration (FNA) cytology and/or imprint of a WBN specimen). For statistical analysis the auditing tool and quality control proposed by the National Health Service breast screening programme was utilised. RESULTS For FNA, full specificity, positive predictive value, inadequate rates and suspicious rates were satisfactory while absolute sensitivity, complete sensitivity, false negatives and false positives were unsatisfactory. For imprint, absolute sensitivity, complete sensitivity, inadequate rate from cancers and suspicious rates were satisfactory, and the remaining indicators were unsatisfactory. WBN displayed the best performance with absolute sensitivity, complete sensitivity, false negative, suspicious rates, full specificity and predictive value showing satisfactory results and only one unsatisfactory result (false positive). CONCLUSIONS Based on an overall analysis, WBN displayed the highest clinical efficacy compared with FNA and imprint, and demonstrated adequate safety for confirming the appropriate diagnosis and management of patients, ensuring the efficacy of the service.
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Mendoza P, Lacambra M, Tan PH, Tse GM. Fine needle aspiration cytology of the breast: the nonmalignant categories. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:547580. [PMID: 21660275 PMCID: PMC3108472 DOI: 10.4061/2011/547580] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/21/2011] [Accepted: 03/21/2011] [Indexed: 11/24/2022]
Abstract
Currently, accurate diagnosis of breast lesions depends on a triple assessment approach comprising clinical, imaging and pathologic examinations. Fine needle aspiration cytology (FNAC) is widely adopted for the pathologic assessment because of its accurracy and ease of use. While much has been written about the atypical and maliganant categories of FNAC diagnosis, little covers the non-malignanat category which represents a sheer number in all FNAC cases. Moreover, any false-negative diagnosis of the non-malignant cases may lead to missed diagnosis of cancer. This paper aims to discuss the issues of smear adequacy, the cytologic features of benign breast lesions and the dilemma of a false-negative aspirate. Much has been suggested about the smear adequacy criterion, including quantifying epithelial clusters, whereas others advocate basing adequacy on qualitative quantum of using noncellular features of FNAC. Various benign lesions could be easily diagnosed at FNAC; however, they have cytologic features overlapped with malignant lesions. False negativity of FNAC does occur; this could be caused by either “true” false-negative cases attributed to suboptimal sampling technique, poor localization of the mass or nonpalpable lesions or “false” false-negative cases due to interpretational errors. Though false-positive cases are less commonly found, they will also be discussed briefly.
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Affiliation(s)
- Paulo Mendoza
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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26
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Rakha EA, Ho BC, Naik V, Sen S, Hamilton LJ, Hodi Z, Ellis IO, Lee AHS. Outcome of breast lesions diagnosed as lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4) on needle core biopsy, including detailed review of epithelial atypia. Histopathology 2011; 58:626-32. [PMID: 21371081 DOI: 10.1111/j.1365-2559.2011.03786.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To provide updated evidence of the outcome of breast lesions of uncertain malignant potential (B3) and suspicious of malignancy (B4) diagnosed on needle core biopsy (NCB) and analyse the outcome of the different types of intraductal epithelial atypia. METHODS AND RESULTS One-hundred and forty-nine B3 and 26 B4 NCBs diagnosed over a 2-year period (2007-2008) were compared with those diagnosed over a previous 2-year period (1998-2000). The proportion of B3 diagnoses increased from 3.1% to 4.5%, and the positive predictive value (PPV) of malignancy of a B3 core decreased from 25% to 10%. Increased diagnosis of radial scar and reductions in the PPV of lobular neoplasia and of atypical intraductal proliferation may explain the reduction in the PPV of the B3 group as a whole. There were no significant changes in the proportion of B4 diagnosis (1.1% and 0.8%) or the PPV of B4 (83% and 88%). Review of cores with intraductal atypia showed a wide range of PPVs, from 100% for suspicious of ductal carcinoma in situ, to 40% for atypical ductal hyperplasia categorized as B3, and 14% for isolated flat epithelial atypia. CONCLUSION The study has found a decrease in the PPV for a B3 diagnosis and suggests possible explanations.
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Affiliation(s)
- Emad A Rakha
- Department of Histopathology, Nottingham University Hospitals, City Hospital Campus, Nottingham, UK
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Rakha EA, Lee AH, Jenkins JA, Murphy AE, Hamilton LJ, Ellis IO. Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening. Int J Cancer 2011; 129:1417-24. [DOI: 10.1002/ijc.25801] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Accepted: 11/04/2010] [Indexed: 11/09/2022]
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Kuo YL, Chang TW. Can concurrent core biopsy and fine needle aspiration biopsy improve the false negative rate of sonographically detectable breast lesions? BMC Cancer 2010; 10:371. [PMID: 20637074 PMCID: PMC2914704 DOI: 10.1186/1471-2407-10-371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 07/16/2010] [Indexed: 12/02/2022] Open
Abstract
Background The aims of this study were to determine the accuracy of concurrent core needle biopsy (CNB) and fine needle aspiration biopsy (FNAB) for breast lesions and to estimate the false-negative rate using the two methods combined. Methods Over a seven-year period, 2053 patients with sonographically detectable breast lesions underwent concurrent ultrasound-guided CNB and FNAB. The sonographic and histopathological findings were classified into four categories: benign, indeterminate, suspicious, and malignant. The histopathological findings were compared with the definitive excision pathology results. Patients with benign core biopsies underwent a detailed review to determine the false-negative rate. The correlations between the ultrasonography, FNAB, and CNB were determined. Results Eight hundred eighty patients were diagnosed with malignant disease, and of these, 23 (2.5%) diagnoses were found to be false-negative after core biopsy. After an intensive review of discordant FNAB results, the final false-negative rate was reduced to 1.1% (p-value = 0.025). The kappa coefficients for correlations between methods were 0.304 (p-value < 0.0001) for ultrasound and FNAB, 0.254 (p-value < 0.0001) for ultrasound and CNB, and 0.726 (p-value < 0.0001) for FNAB and CNB. Conclusions Concurrent CNB and FNAB under ultrasound guidance can provide accurate preoperative diagnosis of breast lesions and provide important information for appropriate treatment. Identification of discordant results using careful radiological-histopathological correlation can reduce the false-negative rate.
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Affiliation(s)
- Yao-Lung Kuo
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan and Dou-Liou Branch, Taiwan
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Diagnosing breast lesions by fine needle aspiration cytology or core biopsy: which is better? Breast Cancer Res Treat 2010; 123:1-8. [DOI: 10.1007/s10549-010-0962-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 05/18/2010] [Indexed: 10/19/2022]
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30
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Ward S, Shepherd J, Khalil H. Freehand versus ultrasound-guided core biopsies of the breast: reducing the burden of repeat biopsies in patients presenting to the breast clinic. Breast 2010; 19:105-8. [DOI: 10.1016/j.breast.2009.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 12/01/2009] [Accepted: 12/05/2009] [Indexed: 11/28/2022] Open
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Engohan-Aloghe C, Hottat N, Cosaert J, Boutemy R, Fayt I, Noël JC. Evaluation of accuracy of fine needle aspiration cytology in BI-RADS3 category breast lesions: cytohistological correlation in 337 cases. Cytopathology 2009; 21:161-3. [PMID: 19744191 DOI: 10.1111/j.1365-2303.2009.00652.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the accuracy of fine needle aspiration cytology (FNAC) in BI-RADS3 breast lesions. METHODS Between January 2004 and December 2007, 337 cases from BI-RADS3 lesions underwent FNAC. Three to six needle passes were made on each patient. In 67 cases (20%) a histological biopsy was performed. Cytological and histological interpretations were performed by the same pathologist. RESULTS The histological diagnosis showed that 88% (59/67) of BI-RADS3 breast lesions were benign. Only 6% (4/67) were malignant, consisting of ductal carcinoma in situ and infiltrating ductal carcinoma. CONCLUSION BI-RADS3 lesions remain disruptive in their management. However, the correlation between cytology and histology showed that most of these lesions were benign and that finally FNAC remains a useful and accurate test in the management of these lesions.
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Affiliation(s)
- C Engohan-Aloghe
- Department of Pathology, Erasme University Hospital, Free University of Brussels (ULB), Brussels, Belgium.
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Lieu D. Value of cytopathologist-performed ultrasound-guided fine-needle aspiration as a screening test for ultrasound-guided core-needle biopsy in nonpalpable breast masses. Diagn Cytopathol 2009; 37:262-9. [DOI: 10.1002/dc.20984] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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El-Sayed ME, Rakha EA, Reed J, Lee AHS, Evans AJ, Ellis IO. Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening. Histopathology 2009; 53:650-7. [PMID: 19076681 DOI: 10.1111/j.1365-2559.2008.03158.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Breast needle core biopsy (NCB) is now a commonplace diagnostic procedure in breast cancer screening, providing accurate diagnoses of both benign and malignant lesions. However, NCB may result in the borderline diagnoses of lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4). The aim was to study a large series of B3 cases from population-based screening subjects in order to evaluate positive predictive values (PPVs) for malignancy. METHODS AND RESULTS The results of 523 NCBs of women screened over a 7-year period (1999-2006) in the East Midlands region, UK, with a B3 diagnosis who underwent surgical excision, were reviewed and compared with the final excision histology. Five percent of NCBs were reported as B3. The most frequent histological subtypes were atypical intraductal epithelial proliferation (AIDEP) and radial scar/complex sclerosing lesion (RS/CSL). Final excision histology was benign in 417 (80%) and malignant in 106 (20%) subjects (60 ductal carcinoma in situ and 46 invasive carcinoma). Lesion-specific PPVs were as follows: AIDEP 32%; lobular neoplasia (LN) 30%; RS/CSL with AIDEP or LN 24%; RS/CSL without atypia 9%; papillary lesion with AIDEP or LN 36%; and papillary lesion without atypia 4%. Five of the 32 fibroepithelial lesions with cellular stroma were phyllodes tumours (four benign and one borderline). None of the five mucinous lesions on NCB was malignant. CONCLUSIONS Our results show that approximately one-fifth of NCB of screen-detected breast lesions classified as B3 are malignant on excision, and the likelihood of malignancy varies substantially between different histological subtypes.
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Affiliation(s)
- M E El-Sayed
- Department of Histopathology, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
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Farshid G, Downey P, Gill P, Pieterse S. Assessment of 1183 screen-detected, category 3B, circumscribed masses by cytology and core biopsy with long-term follow up data. Br J Cancer 2008; 98:1182-90. [PMID: 18382460 PMCID: PMC2359648 DOI: 10.1038/sj.bjc.6604296] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 01/23/2008] [Accepted: 02/12/2008] [Indexed: 11/30/2022] Open
Abstract
Discrete masses are commonly detected during mammographic screening and most such lesions are benign. For lesions without pathognomonically benign imaging features that are still regarded likely to be non-malignant (Tabar grade 3) reliable biopsy results would be a clinically useful alternative to mammographic surveillance. Appropriate institutional guidelines for ethical research were followed. Between Jan 1996--Dec 2005 grade 3B discrete masses detected in the setting of a large, population based, breast cancer screening programme are included. Patient demographics, fine needle aspiration biopsy (FNAB), core and surgical biopsy results are tabulated. The final pathology of excised lesions was obtained. Information regarding interval cancers was obtained from the State Cancer Registry records and also through long term follow-up of clients in subsequent rounds of screening. A total of 1183 lesions, mean diameter of 13.3 mm (+/-8.3 mm) and mean client age of 55.1 years (+/-8.8 years) are included. After diagnostic work up, 98 lesions (8.3%) were malignant, 1083 were non-malignant and a final histologic diagnosis was not established in two lesions. In the 27 months after assessment, no interval cancers were attributable to these lesions and during a mean follow up of 54.5 months, available in 84.9% of eligible women, only one cancer has developed in the same quadrant as the original lesion, although the two processes are believed to be unrelated. FNAB performed in 1149 cases was definitive in 80.5% cases (882 benign, 43 malignant) with a negative predictive value (NPV) of 99.8% (880 of 882) and a positive predictive value (PPV) of 95.2% (40 of 42, both intraductal papillomas). Core biopsy was performed in 178 lesions, mostly for indefinite cytology. Core biopsy was definitive in 79.8% cases (57% benign 22% malignant) with a PPV of 100% and NPV of 99.0%. In experienced hands FNAB is an accurate first line diagnostic modality for the assessment of 3B screen-detected discrete masses, providing definitive results in 80.5% of cases. When used as a second line modality, core biopsy had a similarly high rate of definitive diagnosis at 79.8%. The stepwise approach to the use of FNAB and core biopsy would reduce substantially the proportion of cases requiring surgical diagnostic biopsy. Given the low probability of malignancy and the imperative to limit the morbidity associated with cancer screening, the demonstration of the reliability of FNAB as a minimally invasive but highly accurate test for this particular subset of screen-detected lesions has significant clinical utility.
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Affiliation(s)
- G Farshid
- BreastScreen SA, 1 Goodwood Road, Wayville 5065, South Australia.
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Rakha EA, Ellis IO. An overview of assessment of prognostic and predictive factors in breast cancer needle core biopsy specimens. J Clin Pathol 2007; 60:1300-6. [PMID: 17630399 PMCID: PMC2095575 DOI: 10.1136/jcp.2006.045377] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Needle core biopsy (NCB), as part of triple assessment for preoperative evaluation and diagnosis of breast cancer, is now considered as an established, highly accurate method for diagnosing breast cancer that has replaced either fine needle aspiration cytology or excisional biopsy as the initial diagnostic biopsy procedures in many institutions. In addition to its primary role in establishing an accurate histological diagnosis, NCB can potentially provide important additional pathological prognostic information which may be of direct clinical value in certain situations, such as patients being considered for preoperative (neoadjuvant) therapy. With this background in mind we briefly review the current role of NCB in breast cancer diagnosis and then concentrate this review on the usefulness and issues relating to use of this technique in providing accurate, reliable and clinically relevant preoperative prognostic and predictive information in patients with breast cancer.
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Affiliation(s)
- E A Rakha
- Molecular Medical Sciences, University of Nottingham, Department of Histopathology, Nottingham City Hospital NHS Trust. Nottingham University, Nottingham, UK
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36
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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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38
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Garg S, Mohan H, Bal A, Attri AK, Kochhar S. A comparative analysis of core needle biopsy and fine-needle aspiration cytology in the evaluation of palpable and mammographically detected suspicious breast lesions. Diagn Cytopathol 2007; 35:681-9. [DOI: 10.1002/dc.20721] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lieske B, Ravichandran D, Wright D. Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma. Br J Cancer 2006; 95:62-6. [PMID: 16755293 PMCID: PMC2360502 DOI: 10.1038/sj.bjc.6603211] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Core biopsy (CB) has now largely replaced fine-needle aspiration cytology (FNAC) in the preoperative assessment of breast cancer in the UK. We studied the contribution of FNAC and CB in the preoperative diagnosis of screen-detected breast carcinoma. Data were prospectively collected on 150 840 women who underwent breast screening over a 4-year period from 1999 to 2003. Data on women who had both FNAC and CB taken from the same lesion preoperatively and in whom surgical excision of the lesion subsequently confirmed malignancy was analysed. In 763 cancers, FNAC was inadequate (C1) in 8% and benign (C2) in 10%. Most of these cases presented with microcalcification (25% were C1 or C2). Core biopsy was not representative (B1) or benign (B2) in 7%. The absolute and complete sensitivities were 65 and 82% for FNAC and 80 and 93% for CB in the diagnosis of cancer. Core biopsy was abnormal (B3 or above) in 86% of the cancers missed by FNAC and FNAC was abnormal (C3 or above) in 65% of those missed by CB. Core biopsy is better than FNAC at preoperative diagnosis of screen-detected breast cancer as it missed fewer cancers. However, combining FNAC resulted in a better preoperative diagnosis rate.
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Affiliation(s)
- B Lieske
- Bedfordshire and Hertfordshire Breast Screening Unit and Luton & Dunstable Breast Unit, Luton & Dunstable Hospital, Lewsey Road, Luton, Bedfordshire LU4 0DZ, UK
| | - D Ravichandran
- Bedfordshire and Hertfordshire Breast Screening Unit and Luton & Dunstable Breast Unit, Luton & Dunstable Hospital, Lewsey Road, Luton, Bedfordshire LU4 0DZ, UK
- E-mail:
| | - D Wright
- Bedfordshire and Hertfordshire Breast Screening Unit and Luton & Dunstable Breast Unit, Luton & Dunstable Hospital, Lewsey Road, Luton, Bedfordshire LU4 0DZ, UK
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40
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Iwase T, Takahashi K, Gomi N, Horii R, Akiyama F. Present state of and problems with core needle biopsy for non-palpable breast lesions. Breast Cancer 2006; 13:32-7. [PMID: 16518060 DOI: 10.2325/jbcs.13.32] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The widespread use of screening mammography has resulted in increased detection of nonpalpable breast lesions here in Japan. For the histopathologic work-up of these lesions, stereotactic core biopsy is essential as a minimally invasive diagnostic procedure. However, the number of facilities that provide this procedure cannot keep up with the increasing demand from patients. Another issue is interpreting the results of the biopsy. With a histological diagnosis using needle samples, there is always a risk of underestimation or a false-negative result. To avoid missing cancers after stereotactic biopsy, it is important to check for sampling errors and for discrepancies between the radiologic and pathologic findings. We are pushing for the rapid spread of an ideal form of stereotactic breast core biopsy (using prone-type units, digital methods, and vacuum-assisted breast biopsy devices) throughout Japan so that every patient can undergo this examination.
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Affiliation(s)
- Takuji Iwase
- Department of Breast Surgery, Cancer Institute Hospital, Tokyo 135-8550, Japan
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Wiley A, Katsaros D, Fracchioli S, Yu H. Methylation of the insulin-like growth factor binding protein-3 gene and prognosis of epithelial ovarian cancer. Int J Gynecol Cancer 2006; 16:210-8. [PMID: 16445635 DOI: 10.1111/j.1525-1438.2006.00299.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Insulin-like growth factor binding protein-3 (IGFBP-3) is a member of the IGFBP family, which regulates the mitogenic and antiapoptotic effects of insulin-like growth factors. Hypermethylation of the IGFBP-3 promoter has been found to suppress its expression. To evaluate the role of IGFBP-3 in ovarian cancer progression, we examined the survival of 235 consecutively selected epithelial ovarian cancer patients in association with IGFBP-3 promoter methylation and IGFBP-3 expression in tumor tissue. IGFBP-3 promoter methylation was analyzed using methylation-specific polymerase chain reaction. Cytosol protein was extracted and measured using a bicinchoninic acid assay; IGFBP-3 was measured by enzyme linked immunosorbent assay. Promoter methylation of the IGFBP-3 gene was detected in 44% (104/235) of patients. IGFBP-3 promoter methylation was associated with disease progression and death after adjusting for clinical and pathologic variables. The association was more evident in patients with early-stage disease: RR = 2.87 (95% CI: 0.78-10.63) for disease progression and RR = 3.94 (95% CI: 0.91-15.78) for death. Tissue levels of IGFBP-3 did not differ by methylation status but were inversely associated with disease stage and residual tumor size. These results suggest that IGFBP-3 promoter methylation may be a useful prognostic marker for disease progression and death in early-stage ovarian cancer.
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Affiliation(s)
- A Wiley
- Department of Epidemiology and Public Health, Yale Cancer Center, Yale University School of Medicine, New Haven, CT 06520-8034, USA
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42
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Farshid G, Downey P. Combined use of imaging and cytologic grading schemes for screen-detected breast abnormalities improves overall diagnostic accuracy. Cancer 2006; 105:282-8. [PMID: 15999361 DOI: 10.1002/cncr.21280] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Numeric grading systems have been validated for the reporting of mammographic abnormalities and for breast cytology. The impact of integrating lesion grades from both disciplines on the accuracy of assessment of screen-detected lesions has not been investigated. METHODS In the current study, all lesions were prospectively classified using the Tabar radiologic grading system, as well as the National Health Service Breast Screening Programme (NHSBSP) cytologic reporting system. For lesions assessed between January 1996 and January 2003, based on final histology or 12 months of follow-up, positive predictive values (PPV) were calculated for each imaging grade and for each cytologic grouping. After integration of the data, changes in the PPV and the negative predictive values (NPV) of cytology among lesions with varying imaging grades were tracked. RESULTS Data were retrieved for 4806 lesions. The differences in the rates of malignancy for lesions in the different imaging grades were significant (Grade 5, 95.8%; Grade 4, 54.6%; Grade 3, 11.6%) (P < 0.001). Similarly, the cytologic categories stratified lesions into groups with significantly different rates of malignancy (positive, 99.5%; suspicious, 89.2%; atypical, 43.4%; benign, 5.7%; inadequate, 33.3%) (P < 0.001). Integration of cytologic results with the imaging grade of lesions led to significant improvements in the PPV and NPV. Positive smears were likely to represent malignant lesions in 99.9% of Grade 5 lesions, 99.2% of Grade 4 lesions, and 95.2% of Grade 3 lesions (P < 0.0001). Similarly, negative cytology corresponded to a nonmalignant lesion in 99% of Grade 3 lesions, 81.6% of Grade 4 lesions, and in only 45.5% of Grade 5 lesions (P < 0.001). CONCLUSIONS The integration of numeric grading schemes for breast imaging and cytology improves the accuracy of assessment of screen-detected lesions. Because 99.9% of Grade 5 lesions with positive cytology are malignant, core biopsy confirmation may not be required in this group.
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Harman SM, Gucciardo F, Heward CB, Granstrom P, Barclay-White B, Rogers LW, Ibarra JA. Discrimination of Breast Cancer by Anti-Malignin Antibody Serum Test in Women Undergoing Biopsy. Cancer Epidemiol Biomarkers Prev 2005; 14:2310-5. [PMID: 16214910 DOI: 10.1158/1055-9965.epi-04-0802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The anti-malignin antibody serum (AMAS) test (Oncolab, Boston, MA) has been reported as 97% sensitive and 95% specific for malignancies. To objectively assess accuracy of this test for discrimination of breast cancer, we studied a series of women undergoing core breast biopsy. SUBJECTS AND METHODS Seventy-one core-needle breast biopsies were classified as malignant, suspicious, or benign by two independent pathologists blinded to AMAS results. Corresponding sera were read as AMAS positive, negative, or borderline by criteria used by Oncolab and also using criteria derived from receiver-operator curves based on values for slow (S-tag), fast (F-tag), and their difference (Net-tag) antibody reported by Oncolab. We calculated sensitivity and specificity and analyzed distributions by Fisher's exact test. RESULTS Biopsies were read as 42 (59%) benign, 12 (17%) suspicious, and 17 (24%) malignant. By Oncolab criteria, sensitivity (59%) and specificity (62%) were maximized by pooling suspicious with malignant and AMAS borderline with positive (P = 0.098). Receiver-operator curves showed best sensitivity (62%) and specificity (69%) for the criterion AMAS positive if Net-Tag > 135 microg/mL or S-Tag > 220 microg/mL (P = 0.015). CONCLUSIONS The AMAS test discriminates suspicious and malignant from benign lesions, but sensitivity is insufficient to identify patients to be spared biopsy and false-positive rates are too high for population screening.
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Affiliation(s)
- S Mitchell Harman
- Kronos Longevity Research Institute, 2222 North Highland, Suite 220, Phoenix, AZ 85016, USA.
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Tsunoda-Shimizu H, Nakamura S. Diagnostic assessment of nonpalpable breast cancer-the difference in diagnostic approach for the clinical treatment of breast cancer between the japanese guidelines and the national comprehensive cancer network (USA) guidelines. Breast Cancer 2005; 12:250-7. [PMID: 16286904 DOI: 10.2325/jbcs.12.250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The detection of non-palpating breast cancer might improve the survival of patients with whole breast cancer because it can be diagnosed at an early stage. Therefore, to standardize the quality of patient care, a published assessment guideline is necessary in a clinical setting. For this purpose, Japan and USA have independent guidelines with different approaches. ''The evidence-based guideline for clinical treatment of breast cancer'' that was published in June 2005 by the Japanese breast cancer society, is the first set of integrated guidelines pertaining to breast cancer in Japan. These guidelines are presented in the research questions (RQ)format. This paper explains 7 RQs(out of 31 RQs)and also discusses the recommendations pertaining to the diagnosis of nonpalpable breast cancer. The National Comprehensive Cancer Network (NCCN; USA)guidelines, which are widely recognized as one of the most reliable guidelines based on published evidences, also contain the diagnostic assessment of asymptomatic patients with a negative physical examination. This paper discusses pros and cons of each of the above mentioned guidelines as well as their clinical application. It is necessary to use both the Japanese and NCCN guidelines while understanding the differences between the two.
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Affiliation(s)
- Hiroko Tsunoda-Shimizu
- St Luke's International Hospital Department of Radiology, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
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Douglas-Jones A, Shah V, Morgan J, Dallimore N, Rashid M. Observer variability in the histopathological reporting of core biopsies of papillary breast lesions is reduced by the use of immunohistochemistry for CK5/6, calponin and p63. Histopathology 2005; 47:202-8. [PMID: 16045782 DOI: 10.1111/j.1365-2559.2005.02208.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate agreement on core biopsy diagnosis of papillary breast lesions, which is acknowledged as a difficult area, and to determine the effect of the use of immunohistochemistry (IHC) to assist diagnosis. STUDY DESIGN Haematoxylin and eosin (H&E) sections of 129 core biopsies of papillary breast lesions were circulated to four observers who categorized each case as: B2 (benign), B3a (epithelial proliferation, probably benign but requiring biopsy), B3b (epithelial proliferation with cytological or architectural atypia), B4 (probably malignant but insufficient material or artefact to allow diagnosis), B5 (malignant papillary lesion). In all cases (n = 127) IHC was performed for cytokeratin (CK) 5/6, calponin, p63 (myoepithelial markers), and slides recirculated. RESULTS There was unanimous agreement in 44% of cases on H&E only which rose to 91% after the use of IHC. Overall, unweighted kappa (Ku; five categories) rose from 0.54 to 0.91. The main effect of IHC was to reduce the use of intermediate categories (B3a, B3b and B4) and allow definitive diagnosis (B2 or B5). CONCLUSION Agreement on H&E sections alone in papillary core biopsies of breast is only 44% (Ku = 0.54) but is significantly increased to 91% (Ku = 0.91) by the use of IHC for CK5/6, calponin and p63.
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Affiliation(s)
- A Douglas-Jones
- School of Medicine, Cardiff University and Department of Pathology, University Hospital of Wales, Cardiff, UK.
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Oyama T, Koibuchi Y, McKee G. Core needle biopsy (CNB) as a diagnostic method for breast lesions: Comparison with fine needle aspiration cytology (FNA). Breast Cancer 2004; 11:339-42. [PMID: 15604988 DOI: 10.1007/bf02968040] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In Japan, fine needle aspiration biopsy (FNA) of the breast has long been recognized as a useful diagnostic tool, and has been used in many institutions because it provides a rapid, accurate and cost-effective evaluation. However, the use of core needle biopsy (CNB) is increasing, and vacuum assisted biopsy devices have been developed to produce larger specimens for analysis. CNB is useful because the frequency of inadequate specimens is lower than in FNA, and it requires a less invasive procedure than open biopsy. CNB is also more widely used, compared to FNA, because it can provide a more definitive diagnosis of borderline lesions and can be used to distinguish between IDC and ILC. Therefore, the use of CNB with mammographic or ultrasonographic guidance is especially high for non-palpable tumors. FNA is a rapid and non-invasive procedure that is useful for mass lesions. The accuracy of FNA for non-palpable lesions is relatively low, and depends upon the skill of the aspirators, cytoscreeners and cytopathologists involved in the procedure. However, FNA for palpable masses, coupled with a physical and mammographic examination (the so-called triple test) is highly accurate for diagnosis of breast cancer when all three modalities indicate malignancy, and for a benign lesion when all three are negative.
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Affiliation(s)
- Tetsunari Oyama
- Department of Tumor Pathology, Gunma University, Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
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Jones L, Lott MF, Calder CJ, Kutt E. Imprint cytology from ultrasound-guided core biopsies: accurate and immediate diagnosis in a one-stop breast clinic. Clin Radiol 2004; 59:903-8. [PMID: 15451349 DOI: 10.1016/j.crad.2004.02.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2003] [Revised: 02/03/2004] [Accepted: 02/05/2004] [Indexed: 11/23/2022]
Abstract
AIM To investigate whether imprint cytology from ultrasound-guided core biopsy specimens was adequate for the National Health Service Breast Screening Programme (NHSBSP) guidelines. METHODS We prospectively audited imprint cytology from ultrasound-guided core biopsy specimens. The performance indicators for imprint cytology specimens from 111 consecutive ultrasound-guided core biopsy were compared with standards set by the NHSBSP for fine-needle aspiration cytology (FNAC). RESULTS Imprint cytology fulfilled the "preferred" targets for absolute and complete sensitivity, specificity, positive predictive value, false-positive and false-negative rates, inadequate rate and inadequate rate from cancers. It also satisfied the minimum target for suspicious rate. The complete sensitivity was 97%, full specificity 78%, with 100% positive predictive value for C5 cytology and an inadequate rate from cancers of 1.5%. CONCLUSION Imprint cytology from ultrasound-guided core biopsy allows same-day diagnosis and the collection of data regarding the grade of the carcinoma for treatment decisions from a single needle test.
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Affiliation(s)
- L Jones
- Avon Breast Screening Centre, Central Clinic, Tower Hill, Bristol, UK.
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Farshid G, Rush G. The use of fine-needle aspiration cytology and core biopsy in the assessment of highly suspicious mammographic microcalcifications: analysis of outcome for 182 lesions detected in the setting of a population-based breast cancer screening program. Cancer 2004; 99:357-64. [PMID: 14681944 DOI: 10.1002/cncr.11785] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Fine-needle aspiration biopsy (FNAB) is used as the first-line diagnostic test for lesions that require morphologic assessment in the authors' breast cancer screening program. A positive cytologic diagnosis is an indication to proceed to definitive surgery. Core biopsy is used if FNAB is not diagnostic. In the context of increased use of core biopsy at other centers, the authors reviewed their experience with the cytologic assessment of highly suspicious microcalcifications. METHODS Between January 1996 and June 2000, the dominant radiologic abnormality was classified prospectively as high-grade microcalcifications in 182 lesions. Data were recorded on patient demographics, radiologic features, and the findings of FNAB and core biopsy, if performed. The results of the screening assessment were then compared with the final histologic findings. RESULTS Overall, 15.6% of all radiologically high-grade lesions were microcalcifications. The mean patient age was 58.76 years. The lesions had a mean size of 38.49 mm (range, 5-200 mm), and 92.31% of high-grade microcalcifications proved to be malignant. Among the cases evaluated by FNAB, a positive cytologic diagnosis of malignancy was made in 70.93% of lesions, without any false-positive diagnoses and obviating the need for diagnostic core biopsy. FNAB had a sensitivity of 77.22% and a positive predictive value (PPV) of 100%. When core biopsy was performed due to the absence of a positive cytologic diagnosis, it averted the need for open biopsy in 76% of lesions. CONCLUSIONS Where there is access to skilled cytopathologists, FNAB can provide a highly accurate, rapid, and cost-effective means of triage of patients who would benefit most from the more expensive core biopsy.
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Wong CS, Rubin CM, Briley MS, Royle GT. Re: Surgeon-controlled ultrasound-guided core biopsies in the breast—a prospective study and a new use for surgeons in the clinic. Eur J Surg Oncol 2003; 29:700. [PMID: 14511623 DOI: 10.1016/s0748-7983(03)00102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Hoda SA, Harigopal M, Harris GC, Pinder SE, Lee AHS, Ellis IO. Expert opinion: Reporting needle core biopsies of breast carcinomas. Histopathology 2003; 43:84-90. [PMID: 12823716 DOI: 10.1046/j.1365-2559.2003.01625.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Many breast carcinomas are now diagnosed in needle core biopsies, after either mammographic detection or symptomatic presentation. There is dispute, however, about the range of information that should be included in the diagnostic report of these small and possibly unrepresentative samples. Is it sufficient to simply report the presence of carcinoma, in situ or invasive? Or should the histopathologist give a more detailed report including features of prognostic and predictive significance? If so, what is the evidence that the further information is, first, of clinical benefit and, second, not unreliable because of sampling variability? To address the question "What should be included in reports of needle core biopsies of breast carcinomas?" contributions were invited from authors in the USA and the UK.
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Affiliation(s)
- S A Hoda
- The Department of Pathology, Weill Medical College of Cornell University and New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
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