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ALTINTAŞ S, BAYRAK M. COVID-19 pandemisinin meme kanser teşhis sürecine etkisi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1103193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Purpose: The primary aim of thşis study was to evaluate difference in the number of patients with tru-cut biopsies to diagnose breast lesions between non-pandemic and pandemic periods.
Materials and Methods: In this study, the nonpandemic period and the pandemic period were compared, the periods for the pandemic times, between March 1, 2018, and 29 February 2020, and for the nonpandemic period, 1 March 2020 to 12 March 2022 to 12 March 2022. In each period, we have included all the tru-cut biopsies for suspected breast cancer. During the pandemic and non-pandemic period, the number of tru-cut biopsies BI-RADS and histopathological findings of the patients who experienced tru-cut biopsies were compared.
Results: The number of tru-cut biopsies performed during the nonpandemic and pandemic period was similar (1596, 1599). In the pandemic period, tru-cut biopsy histopathologic reports revealed that benign and high-risk cases decreased statistically, while invasive carcinoma cases increased by 1.9 (95% CI 1.6-2.2) times. During the pandemic period, US-guided BI-RADS 3 and BI-RADS 4a cases decreased statistically significantly, BBI-RADS 4b cases increased 1.4 (95% CI 1.1-2.2) times, BI-RADS 4c cases 1.7 (95% CI 1.2-2.2), BI-RADS 5 cases increased 2.1 (95% CI 1.4-3.1) times
Conclusion: There was no significant change in tru-cut biopsy numbers compared to the period of the pandemic and the non-pandemic period. However, the stage of the cancers captured during the period of the pandemic was higher.
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Affiliation(s)
- Süleyman ALTINTAŞ
- UNIVERSITY OF HEALTH SCIENCES, ADANA NUMUNE HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF MEDICAL PATHOLOGY
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Liu Y, Wang X, Zheng A, Yu X, Jin Z, Jin F. Breast Lesions Diagnosed as Ductal Carcinoma In Situ by Ultrasound-Guided Core Needle Biopsy: Risk Predictors for Concomitant Invasive Carcinoma and Axillary Lymph Node Metastasis. Front Oncol 2021; 11:717198. [PMID: 34568047 PMCID: PMC8461168 DOI: 10.3389/fonc.2021.717198] [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: 05/30/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background The major concern over preoperatively diagnosed ductal carcinoma in situ (DCIS) of breast via ultrasound-guided core needle biopsy (US-CNB) is the risk of missing concomitant invasive carcinoma. It is crucial to identify risk predictors for such a phenomenon and evaluate its impact on axillary conditions to help surgeons determine which patients should receive appropriate axillary lymph node management. Methods Medical records of 260 patients preoperatively diagnosed with DCIS via 14-gauge CNB were retrospectively analyzed. All of them underwent subsequent surgery at our institution and were successively divided into invasive and non-invasive groups, and metastatic and non-metastatic groups according to pathology of resected specimens and metastasis of axillary lymph nodes (ALNs). Predictive value of preoperative physical examinations, imaging findings, histopathological findings, and hematological indexes for pathological underestimation and metastasis of ALN was assessed by logistic regression analysis. Results The concomitant invasive carcinoma was overlooked in 75 out of 260 patients (29.3%). Multivariate analysis revealed that presence of microinvasion, presence of abnormal lymph node on ultrasound, and absent linear or segmental distributed calcification on mammography were independent risk predictors for invasive carcinoma. Fourteen patients had lymph node metastasis, and five of them were in the non-invasive group. The presence of abnormal lymph node on ultrasound and increased ratio of platelet distribution width to platelet crit (PDW/PCT) (>52.85) were identified as independent risk predictors for ALN metastasis. Conclusion For patients diagnosed with DCIS preoperatively, appropriate ALN management is necessary if they have risk predictors for concomitant invasive carcinoma and ALN metastasis.
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Affiliation(s)
- Yanbiao Liu
- Department of Breast Surgery, The 1st Affiliated Hospital, China Medical University, Shenyang, China
| | - Xu Wang
- Department of Breast Surgery, The 1st Affiliated Hospital, China Medical University, Shenyang, China
| | - Ang Zheng
- Department of Breast Surgery, The 1st Affiliated Hospital, China Medical University, Shenyang, China
| | - Xinmiao Yu
- Department of Breast Surgery, The 1st Affiliated Hospital, China Medical University, Shenyang, China
| | - Zining Jin
- Department of Breast Surgery, The 1st Affiliated Hospital, China Medical University, Shenyang, China
| | - Feng Jin
- Department of Breast Surgery, The 1st Affiliated Hospital, China Medical University, Shenyang, China
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Zhan H, Quinn M, Tian W, Yan L, Khoury T. Significance of Removing Comedonecrosis as an Exclusion Criterion in Mammary Low-Risk Ductal Carcinoma In Situ Managed in an Active Surveillance Clinical Trial. Am J Clin Pathol 2021; 156:596-606. [PMID: 33769445 DOI: 10.1093/ajcp/aqaa276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This study aims to investigate the consequences of comedonecrosis omission as an exclusion criterion of the Comparison of Operative vs Monitoring and Endocrine Therapy (COMET) trial. METHODS The clinical inclusion criteria of the COMET trial were applied on women who were mammographically screened between 2007 and 2017 and had a diagnosis of low- or intermediate-grade ductal carcinoma in situ (DCIS). The percentage of ductal diameter occupied by necrosis was calculated. RESULTS Twenty-six of 129 (20.2%) cases were upgraded. Larger calcification span correlated with upgrade (P = .02), with the best cutoff of 1.1 cm, and negative predictive value of 86%. When solely analyzing cases with no comedonecrosis (n = 76), none of the variables correlated with upgrade. Comedonecrosis was significantly correlated with upgrade to invasive carcinoma (P = .041), with the best cutoff of 53% of ductal diameter occupied by necrosis. CONCLUSIONS Results indicate that comedonecrosis and span of mammographic calcifications could be risk factors in women managed with active surveillance.
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Affiliation(s)
- Haiying Zhan
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Marie Quinn
- Department of Radiology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Wanqing Tian
- Department of Biostatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Li Yan
- Department of Biostatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Thaer Khoury
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Pure Ductal Carcinoma In Situ of the Breast: Analysis of 270 Consecutive Patients Treated in a 9-Year Period. Cancers (Basel) 2021; 13:cancers13030431. [PMID: 33498737 PMCID: PMC7865419 DOI: 10.3390/cancers13030431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/19/2021] [Indexed: 11/27/2022] Open
Abstract
Simple Summary Ductal carcinoma in situ (DCIS) accounts for 20 to 25% of all breast cancers and its incidence of progression to invasive ductal carcinoma is at least 13 to 50%. The aim of our retrospective observational analysis is to review the issues of this histological type of cancer. We confirmed in a wide population of 270 consecutive patients who underwent surgery in a single institute that the management of DCIS can be difficult and particularly complex. There are many variables to be taken into consideration such as the choice of the diagnostic and bioptical technique. This delicate management must be carried out in specialized centres such as Breast Units involving multiple professional figures to define and guarantee the best possible treatment for each patient. Abstract Introduction: Ductal carcinoma in situ (DCIS) is an intraductal neoplastic proliferation of epithelial cells that are confined within the basement membrane of the breast ductal system. This retrospective observational analysis aims at reviewing the issues of this histological type of cancer. Materials and methods: Patients treated for DCIS between 1 January 2009 and 31 December 2018 were identified from a retrospective database. The patients were divided into two groups of 5 years each, the first group including patients treated from 2009 to 2013, and the second group including patients treated from 2014 to 2018. Once the database was completed, we performed a statistical analysis to see if there were significant differences among the 2 periods. Statistical analyses were performed using GraphPad Prism software for Windows, and the level of significance was set at p < 0.05. Results: 3586 female patients were treated for breast cancer over the 9-year study period (1469 patients from 2009 to 2013 and 2117 from 2014 to 2018), of which 270 (7.53%) had pure DCIS in the final pathology. The median age of diagnosis was 59-year-old (range 36–86). In the first period, 81 (5.5%) women out of 1469 had DCIS in the final pathology, in the second, 189 (8.9%) out of 2117 had DCIS in the final pathology with a statistically significant increase (p = 0.0001). From 2009 to 2013, only 38 (46.9%) were in stage 0 (correct DCIS diagnosis) while in the second period, 125 (66.1%) were included in this stage. The number of patients included in clinical stage 0 increased significantly (p = 0.004). In the first period, 48 (59.3%) specimen margins were at a greater or equal distance than 2 mm (negative margins), between 2014 and 2018; 137 (72.5%) had negative margins. Between 2014 and 2018 the number of DCIS patients with positive margins decreased significantly (p = 0.02) compared to the first period examined. The mastectomies number increased significantly (p = 0.008) between the 2 periods, while the sentinel lymph node biopsy (SLNB) numbers had no differences (p = 0.29). For both periods analysed all the 253 patients who underwent the follow up are currently living and free of disease. We have conventionally excluded the 17 patients whose data were lost. Conclusion: The choice of the newest imaging techniques and the most suitable biopsy method allows a better pre-operative diagnosis of the DCIS. Surgical treatment must be targeted to the patient and a multidisciplinary approach discussed in the Breast Unit centres.
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Jung I, Han K, Kim MJ, Moon HJ, Yoon JH, Park VY, Kim EK. Annual Trends in Ultrasonography-Guided 14-Gauge Core Needle Biopsy for Breast Lesions. Korean J Radiol 2020; 21:259-267. [PMID: 32090518 PMCID: PMC7039722 DOI: 10.3348/kjr.2019.0695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/16/2019] [Indexed: 11/15/2022] Open
Abstract
Objective To examine time trends in ultrasonography (US)-guided 14-gauge core needle biopsy (CNB) for breast lesions based on the lesion size, Breast Imaging-Reporting and Data System (BI-RADS) category, and pathologic findings. Materials and Methods We retrospectively reviewed consecutive US-guided 14-gauge CNBs performed from January 2005 to December 2016 at our institution. A total of 22,297 breast lesions were included. The total number of biopsies, tumor size (≤ 10 mm to > 40 mm), BI-RADS category (1 to 5), and pathologic findings (benign, high risk, ductal carcinoma in situ [DCIS], invasive cancer) were examined annually, and the malignancy rate was analyzed based on the BI-RADS category. Results Both the total number of US scans and US-guided CNBs increased while the proportion of US-guided CNBs to the total number of US scans decreased significantly. The number of biopsies classified based on the tumor size, BI-RADS category, and pathologic findings all increased over time, except for BI-RADS categories 1 or 2 and category 3 (odds ratio [OR] = 0.951 per year, 95% confidence interval [CI]: 0.902, 1.002 and odds ratio = 0.979, 95% CI: 0.970, 0.988, respectively). Both the unadjusted and adjusted total malignancy rates and the DCIS rate increased significantly over time. BI-RADS categories 4a, 4b, and 4c showed a significant increasing trend in the total malignancy rate and DCIS rate. Conclusion The malignancy rate in the results of US-guided 14-gauge CNB for breast lesions increased as the total number of biopsies increased from 2005 to 2016. This trend persisted after adjusting for the BI-RADS category.
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Affiliation(s)
- Inha Jung
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Yonsei Biomedical Research Institute, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Vivian Youngjean Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Gruber I, Oberlechner E, Heck K, Hoopmann U, Böer B, Fugunt R, Gall C, Hartkopf AD, Helms G, Hoffmann SM, Ott C, Röhm C, Stäbler A, Wallwiener D, Brucker SY, Hahn M. Percutaneous Ultrasound-Guided Core Needle Biopsy: Comparison of 16-Gauge versus 14-Gauge Needle and the Effect of Coaxial Guidance in 1065 Breast Biopsies - A Prospective Randomized Clinical Noninferiority Trial. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:534-543. [PMID: 31791085 DOI: 10.1055/a-1014-2628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Ultrasound-guided core needle biopsy (CNB) is considered the standard assessment to diagnose sonographically visible suspicious breast mass lesions. Based on nonrandomized trials, the current German guidelines recommend at least three cylinders with ≤ 14-gauge needle biopsy. However, no recommendation is made as to how many specimens are needed with a smaller needle size, such as 16-gauge, or if biopsy with coaxial guidance improves diagnostic accuracy and quality. Therefore, in a prospective monocentric unblinded randomized controlled clinical noninferiority trial, the diagnostic accuracy of 16-gauge versus 14-gauge core needle biopsy, with and without coaxial guidance, was evaluated. MATERIALS AND METHODS 1065 breast biopsies were included in order to analyze the number of core samples necessary to obtain an appropriate rate of diagnostic quality adequate for histological evaluation, and to achieve high diagnostic accuracy and diagnostic yield. Histological results were verified by surgery or long-term follow-up of at least two years up to five years. RESULTS In order to obtain an additive diagnostic accuracy of > 99 %, a minimum of two cylinders with 14-gauge biopsy were required. The diagnostic accuracy and the diagnostic quality of 14-gauge biopsy were not affected by the coaxial technique. When performing a 16-gauge biopsy, five cylinders were required to achieve an additive diagnostic accuracy of > 99 %. Without coaxial guidance, 16-gauge CNB required at least three samples, whereas five needle passes with coaxial-guided 16-gauge biopsy were needed. CONCLUSION The diagnostic accuracy and quality of ultrasound-guided 16-gauge core needle biopsy were inferior to the 14-gauge needle size, regardless of the use of a coaxial technique.
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Affiliation(s)
- Ines Gruber
- Department of Women's Health, University of Tübingen, Germany
| | | | - Kerstin Heck
- Frauenklinik, Klinikum Stuttgart Olgahospital Frauenklinik, Stuttgart, Germany
| | - Uta Hoopmann
- Department of Women's Health, University of Tübingen, Germany
| | - Bettina Böer
- Department of Women's Health, University of Tübingen, Germany
| | - Regina Fugunt
- Department of Women's Health, University of Tübingen, Germany
| | - Christian Gall
- Department of Women's Health, University of Tübingen, Germany
| | | | - Gisela Helms
- Department of Women's Health, University of Tübingen, Germany
| | | | - Claudia Ott
- Department of Women's Health, University of Tübingen, Germany
| | - Carmen Röhm
- Department of Women's Health, University of Tübingen, Germany
| | - Annette Stäbler
- Institute of Pathology and Neuropathology, University of Tübingen, Germany
| | | | - Sara Y Brucker
- Department of Women's Health, University of Tübingen, Germany
| | - Markus Hahn
- Department of Women's Health, University of Tübingen, Germany
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Abstract
Atypical ductal hyperplasia (ADH) is a proliferative, nonobligate precursor breast lesion and a marker of increased risk for breast carcinoma. Surgical excision remains the standard recommendation following a core needle biopsy result consistent with ADH. Recent research suggests that women with no mass lesion or discordance, removal of greater than or equal to 90% of calcifications at the time of core needle biopsy, involvement of less than or equal to 2 terminal duct lobular units, and absence of cytologic atypia or necrosis are likely to have a less than 5% chance of a missed cancer.
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Affiliation(s)
- Jennifer M Racz
- Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Co M, Kwong A, Shek T. Factors affecting the under-diagnosis of atypical ductal hyperplasia diagnosed by core needle biopsies – A 10-year retrospective study and review of the literature. Int J Surg 2018; 49:27-31. [DOI: 10.1016/j.ijsu.2017.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022]
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Jung I, Kim MJ, Moon HJ, Yoon JH, Kim EK. Ultrasonography-guided 14-gauge core biopsy of the breast: results of 7 years of experience. Ultrasonography 2018; 37:55-62. [PMID: 28641365 PMCID: PMC5769943 DOI: 10.14366/usg.17028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/28/2017] [Accepted: 05/17/2017] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study assessed the outcomes of ultrasound (US)-guided core needle biopsies (CNBs) of breast lesions with at least 2 years of follow-up to determine the false-negative rate and to evaluate the diagnostic accuracy of CNB. METHODS We retrospectively analyzed 13,254 consecutive US-guided 14-gauge CNBs for breast lesions. We excluded biopsies if non-malignant biopsy result was not confirmed by surgical excision or US-guided vacuum-assisted biopsy, or fewer than 2 years of follow-up data were available. A total of 4,186 biopsies were excluded, and 9,068 breast masses from 7,039 women were included. The pathologic findings from each CNB were assessed using the standard diagnostic reference, defined based on the results of surgical excision, vacuum-assisted biopsy, or at least 2 years of long-term imaging follow-up. The false-negative rate and underestimation rate were calculated. RESULTS Of the 9,068 CNBs, benign pathology was found in 64.2%, high-risk results in 3.5%, and malignant results in 32.3%. Of the 5,821 benign CNBs, an additional malignancy was found at excision in 63 lesions, leading to a false-negative rate of 2.0% (63 of 3,067). The underestimation rate was 33.6% (111 of 330) for ductal carcinoma in situ and 24.5% (79 of 322) for high-risk results at surgical excision. Most false-negative diagnoses (84.1%, 53 of 63) were recognized through imaging-histology correlations, and immediate rebiopsies were performed. Ten malignancies (15.9%, 10 of 63) had delayed diagnoses and showed progression in follow-up US imaging. CONCLUSION US-guided 14-gauge CNB provided optimal diagnostic information. Imaging-histology correlations and appropriate imaging follow-up should be performed to avoid delayed diagnoses.
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Affiliation(s)
- Inha Jung
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Current Approaches to Diagnosis and Treatment of Ductal Carcinoma In Situ and Future Directions. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2017; 151:33-80. [PMID: 29096897 DOI: 10.1016/bs.pmbts.2017.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The presentation and treatment of ductal carcinoma in situ (DCIS) has changed substantially over the years. While previously an incidental pathologic finding in more advanced, palpable tumors, the institution of screening mammography has repositioned this disease entity as one largely diagnosed as a non-palpable lesion, often prior to any invasive disease. As DCIS is a precursor to invasive carcinoma, evolution in the approach to treatment has followed in the footsteps of that for invasive disease, including breast conservation therapy, adjuvant radiation, and use of antihormonal therapy. Survival outcomes for DCIS are very high and more recent literature has investigated tailoring therapeutic approaches to avoid overtreatment. Two important areas of ongoing clinical debate concerning overtreatment include use of preoperative MRI and the role of adjuvant radiation. The heterogeneity of the disease makes it difficult to differentiate lesions that would benefit from more aggressive treatment from those in which overtreatment could be avoided. Clinical characteristics, such as histologic appearance, age at diagnosis, and margin status at tumor excision have been established as moderate predictors of disease recurrence, but none has provided strong enough evidence as to guide consensus decisions on adjuvant therapy. Continuing research seeks to define the genetic and molecular characteristics that can predict disease course and serve as the potential targets for novel therapeutic agents. While several markers have shown promise in differentiating tumor aggressiveness, there is still much to be discovered about the precise mechanisms of disease progression and how this can be applied clinically to optimize treatment.
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Tsuchiya K, Mori N, Schacht DV, Sheth D, Karczmar GS, Newstead GM, Abe H. Value of breast MRI for patients with a biopsy showing atypical ductal hyperplasia (ADH). J Magn Reson Imaging 2017; 46:1738-1747. [PMID: 28295791 DOI: 10.1002/jmri.25694] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/13/2017] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the diagnostic value of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for patients with atypical ductal hyperplasia (ADH) in predicting malignant upgrade. MATERIALS AND METHODS 3T DCE-MRI was performed for 17 patients with ADH (median age 52, range 42-76) proven by stereotactic biopsy (n = 15), and ultrasound-guided biopsy (n = 2) from January 2011 to April 2015. All patients underwent surgical excision after the MRI. Two radiologists prospectively reviewed the MRI to determine the presence or absence of suspicious findings at the site of biopsy, and evaluated the MR features of any lesion present according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. MRI findings and clinical information were correlated with the final surgical pathology by multivariate analysis. RESULTS Nine of 17 lesions were upgraded to malignancy. MRI demonstrated suspicious nonmass enhancement (NME) at the site of biopsy in all upgraded patients. The median size was 19.5 mm (range, 9-44 mm). In the eight patients without upgrade, no enhancement (n = 2), linear enhancement along the biopsy track (n = 4), thin rim enhancement around hematoma (n = 1), and a focal NME (n = 1) were seen. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI findings were 100, 87.5, 90, and 100%, respectively. Multivariate analysis revealed that the presence of suspicious enhancement on MRI was the most significant predictor of upgrade to malignancy (P = 0.0006) CONCLUSION: Our study revealed a high NPV of DCE-MRI for patients with ADH in terms of malignant upgrade at subsequent surgery. This suggests that patients with ADH without suspicious enhancement on DCE-MRI might be followed with DCE-MRI rather than undergoing surgical excision. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1738-1747.
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Affiliation(s)
- Keiko Tsuchiya
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - David V Schacht
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Deepa Sheth
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | | | | | - Hiroyuki Abe
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
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Perlman KL, Shelby RA, Wren AA, Kelleher SA, Dorfman CS, O'Connor E, Kim C, Johnson KS, Soo MS. Positive and negative mood following imaging-guided core needle breast biopsy and receipt of biopsy results. PSYCHOL HEALTH MED 2016; 22:1149-1162. [PMID: 28007008 DOI: 10.1080/13548506.2016.1271438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Positive and negative mood are independent psychological responses to stressful events. Negative mood negatively impacts well-being and co-occurring positive mood leads to improved adjustment. Women undergoing core needle breast biopsies (CNB) experience distress during CNB and awaiting results; however, influences of mood are not well known. This longitudinal study examines psychosocial and biopsy- and spirituality-related factors associated with mood in patients day of CNB and one week after receiving results. Ninety women undergoing CNB completed questionnaires on psychosocial factors (chronic stress, social support), biopsy experiences (pain, radiologist communication), and spirituality (peace, meaning, faith) day of CNB. Measures of positive and negative mood were completed day of CNB and one week after receiving results (benign n = 50; abnormal n = 25). Multiple linear regression analyses were conducted. Greater positive mood correlated with greater peace (β = .25, p = .02) day of CNB. Lower negative mood correlated with greater peace (β = -.29, p = .004) and there was a trend for a relationship with less pain during CNB (β = .19, p = .07). For patients with benign results, day of CNB positive mood predicted positive mood post-results (β = .31, p = .03) and only chronic stress predicted negative mood (β = .33, p = .03). For women with abnormal results, greater meaning day of CNB predicted lower negative mood post-results (β = -.45, p = .03). Meaning and peace may be important for women undergoing CNB and receiving abnormal results.
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Affiliation(s)
- Katherine L Perlman
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Rebecca A Shelby
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Anava A Wren
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Sarah A Kelleher
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Caroline S Dorfman
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Erin O'Connor
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center (DUMC) , Durham , NC , USA
| | - Connie Kim
- b Department of Radiology, Breast Imaging Division , DUMC , Durham , NC , USA
| | - Karen S Johnson
- b Department of Radiology, Breast Imaging Division , DUMC , Durham , NC , USA
| | - Mary Scott Soo
- b Department of Radiology, Breast Imaging Division , DUMC , Durham , NC , USA
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Duarte C, Bastidas F, de los Reyes A, Martínez MC, Hurtado G, Gómez MC, Sánchez R, Manrique J. Randomized controlled clinical trial comparing radioguided occult lesion localization with wire-guided lesion localization to evaluate their efficacy and accuracy in the localization of nonpalpable breast lesions. Surgery 2015; 159:1140-5. [PMID: 26549819 DOI: 10.1016/j.surg.2015.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/21/2015] [Accepted: 09/24/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to compare the radioguided occult lesion localization (ROLL) technique with the wire-guided lesion localization (WGLL) technique to assess their efficacy and accuracy in the localization of nonpalpable breast lesions in patients at a unique reference medical center. These patients' reports were negative for malignancy but included highly suspicious imaging findings. METHODS A controlled clinical trial was designed to compare the WGLL and ROLL techniques in women presenting with breast lesions diagnosed by mammography or ultrasonography at the Instituto Nacional de Cancerología in Bogotá, Colombia, from March 2006 to June 2011. RESULTS This study examined 129 patients; 64 (49.6%) patients were treated with ROLL, and 65 (51.4%) were treated with WGLL. The ROLL technique achieved better median lesion centricity (ROLL = 11.7 and WGLL = 15.4; P = .038). No significant differences were found regarding demographic variables, operative specimen characteristics, the need to extend margins, operative complications, the degree of difficulty, or patient or surgeon satisfaction. CONCLUSION The ROLL technique is as effective as WGLL for the localization of nonpalpable breast lesions. In our study, ROLL achieved better lesion centricity. Therefore, we propose that this technique could be used as a standard procedure in the detection of nonpalpable breast lesions at experienced centers.
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Affiliation(s)
- Carlos Duarte
- Grupo de Cirugía de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá D.C., Colombia.
| | - Faustino Bastidas
- Grupo de Cirugía de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
| | - Amelia de los Reyes
- Grupo de Medicina Nuclear, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
| | | | - Gloria Hurtado
- Grupo de Imágenes Diagnósticas, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
| | | | - Ricardo Sánchez
- Grupo de Investigación Clínica, Instituto Nacional de Cancerología, Bogotá D.C., Colombia; Facultad de Medicina Universidad Nacional de Colombia, Bogotá D.C., Colombia
| | - Jorge Manrique
- Grupo de Cirugía de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
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Poole BB, Wecsler JS, Sheth P, Sener SF, Wang L, Larsen L, Tripathy D, Lang JE. Malignancy rates after surgical excision of discordant breast biopsies. J Surg Res 2015; 195:152-7. [PMID: 25519987 DOI: 10.1016/j.jss.2014.11.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 11/19/2014] [Accepted: 11/21/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vacuum-assisted core-needle biopsy (VAB) is increasingly used to perform breast biopsies instead of automated-gun core-needle biopsy (CNB). The significance of discordance between radiologic and pathologic findings has not been well established in the era of VAB predominance. This retrospective study was conducted to determine the rate of malignancy after surgical excisional biopsy (EXB) of these lesions at our two institutions. MATERIALS AND METHODS We reviewed medical records from January 2008-June 2013 to identify female patients who underwent EXB for a Breast Imaging-Reporting and Data System (BI-RADS) 4 or 5 lesions found to be benign and discordant on CNB. Clinicopathologic data were gathered, and analysis was performed using descriptive statistics. RESULTS A total of 8081 core biopsies were performed in the study timeframe. Six of 81 (7.4%) patients who had an EXB for a benign discordant breast lesion were found to have malignant pathology (two invasive, four in situ). Four of 63 (6.3%) lesions originally biopsied by VAB were upgraded, compared with 2 of 17 (11.8%) originally biopsied by CNB. There were no statistically significant differences in the rates of upgrade to malignancy when data were stratified by BI-RADS score or method of biopsy. CONCLUSIONS The overall rate of malignancy after EXB of benign discordant lesions was 7.4%. Despite the widespread adoption of VAB, EXB is still warranted for clarification of discordant radiologic-pathologic findings.
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Affiliation(s)
- Barish B Poole
- Keck School of Medicine, University of Southern California (USC), Los Angeles, California
| | - Julie S Wecsler
- Department of Surgery, Section of Breast and Soft Tissue Surgery, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Pulin Sheth
- Department of Radiology, Division of Breast Imaging, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Stephen F Sener
- Department of Surgery, Section of Breast and Soft Tissue Surgery, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Lina Wang
- Department of Pathology, Keck Hospital of USC, Los Angeles, California
| | - Linda Larsen
- Department of Radiology, Division of Breast Imaging, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Debu Tripathy
- Department of Medicine, Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Julie E Lang
- Department of Surgery, Section of Breast and Soft Tissue Surgery, USC Norris Comprehensive Cancer Center, Los Angeles, California.
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Yu CC, Ueng SH, Cheung YC, Shen SC, Kuo WL, Tsai HP, Lo YF, Chen SC. Predictors of Underestimation of Malignancy after Image-Guided Core Needle Biopsy Diagnosis of Flat Epithelial Atypia or Atypical Ductal Hyperplasia. Breast J 2015; 21:224-32. [DOI: 10.1111/tbj.12389] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Chi-Chang Yu
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Yun-Chung Cheung
- Department of Diagnostic Radiology; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Shih-Che Shen
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Wen-Lin Kuo
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Hsiu-Pei Tsai
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Yung-Feng Lo
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
| | - Shin-Cheh Chen
- Department of Surgery; Chang Gung Memorial Hospital; Chang Gung University Medical College; Taoyuan Taiwan
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16
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Park SH, Kim MJ, Kim SJ, Kim EK. Ductal carcinoma in situ diagnosed using an ultrasound-guided 14-gauge core needle biopsy of breast masses: can underestimation be predicted preoperatively? Ultrasonography 2014; 33:128-35. [PMID: 24936506 PMCID: PMC4058978 DOI: 10.14366/usg.13028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 02/10/2014] [Indexed: 12/15/2022] Open
Abstract
Purpose: This study was designed to determine the rate of ductal carcinoma in situ (DCIS)underestimation diagnosed after an ultrasound-guided 14-gauge core needle biopsy (US-14G-CNB) of breast masses and to compare the clinical and imaging characteristics between trueDCIS and underestimated DCIS identified following surgical excision. Methods: Among 3,124 US-14G-CNBs performed for breast masses, 69 lesions in 60 patients were pathologically-determined to be pure DCIS. We classified these patients according to the final pathology after surgical excision as those with invasive ductal carcinoma (underestimated group) and those with DCIS (non-underestimated group). We retrospectively reviewed and compared the clinical and imaging characteristics between the two groups. Results: Of the 69 lesions, 21 were shown after surgery to be invasive carcinomas; the rateof DCIS underestimation was 30.4%. There were no statistically significant differences withrespect to the clinical symptoms, age, lesion size, mammographic findings, and ultrasonographic findings except for the presence of abnormal axillary lymph nodes as detected on ultrasound. The lesions in 2 patients in the non-underestimated group (2/41, 4.9%) and 5 patients in the underestimated group (5/19, 26.3%) were associated with abnormal lymph nodes on axillary ultrasound, and the presence of abnormal axillary lymph nodes on ultrasound was tatistically significant (P=0.016). Conclusion: We found a 30.4% rate of DCIS underestimation in breast masses based on a US-14G-CNB. The presence of abnormal lymph nodes as detected on axillary ultrasound may be useful to preoperatively predict underestimation.
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Affiliation(s)
- Sung Hee Park
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea ; Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Jin Kim
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea ; Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
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Microcalcifications Detected as an Abnormality on Screening Mammography: Outcomes and Followup over a Five-Year Period. Int J Breast Cancer 2013; 2013:458540. [PMID: 24194985 PMCID: PMC3806370 DOI: 10.1155/2013/458540] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 08/17/2013] [Indexed: 11/17/2022] Open
Abstract
Objectives. This study reviewed the outcome of women attending a breast screening program recalled for assessment of microcalcifications and examined the incidence of a breast carcinoma detected during the following five years in any of the women who were given a benign diagnosis at assessment. Method. A retrospective study consisted of 235 clients attending an Australian BreastScreen program in 2003, who were recalled for investigation of microcalcifications detected on screening mammography. Records for the following five years were available for 168 women in the benign outcome group including those who did not require biopsy at initial assessment. Results. Malignant disease was detected in 26.0% (n = 146) of the women who underwent biopsy. None of the women in the benign outcome group, with available five-year follow-up records, developed a subsequent breast cancer, arising from the calcifications initially recalled in 2003. Conclusions. This study highlights the effectiveness of an Australian screening program in diagnosing malignancy in women with screen detected microcalcification. This has been achieved by correctly determining 38% (n = 235) of the women as benign without the need for biopsy or early recall. A low rate of open surgical biopsies was performed with no cancer diagnoses missed at the time of initial assessment.
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18
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Frequency of Carcinoma at Secondary Imaging-Guided Percutaneous Breast Biopsy Performed After a High-Risk Pathologic Result at Primary Biopsy. AJR Am J Roentgenol 2013; 201:439-47. [DOI: 10.2214/ajr.11.7693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Perrot N, Jalaguier-Coudray A, Frey I, Thomassin-Naggara I, Chopier J. US-guided core needle biopsy: false-negatives. How to reduce them? Eur J Radiol 2012; 82:424-6. [PMID: 22483600 DOI: 10.1016/j.ejrad.2012.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Perrot
- Radiology Department, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France.
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20
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21
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Wiratkapun C, Patanajareet P, Wibulpholprasert B, Lertsithichai P. Factors associated with upstaging of ductal carcinoma in situ diagnosed by core needle biopsy using imaging guidance. Jpn J Radiol 2011; 29:547-53. [DOI: 10.1007/s11604-011-0595-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 03/28/2011] [Indexed: 11/24/2022]
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22
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Nguyen CV, Albarracin CT, Whitman GJ, Lopez A, Sneige N. Atypical Ductal Hyperplasia in Directional Vacuum-Assisted Biopsy of Breast Microcalcifications: Considerations for Surgical Excision. Ann Surg Oncol 2010; 18:752-61. [DOI: 10.1245/s10434-010-1127-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Indexed: 11/18/2022]
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23
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Sinn HP, Elsawaf Z, Helmchen B, Aulmann S. Early Breast Cancer Precursor Lesions: Lessons Learned from Molecular and Clinical Studies. Breast Care (Basel) 2010; 5:218-226. [PMID: 22590441 PMCID: PMC3346166 DOI: 10.1159/000319624] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), and lobular neoplasia (LN) form a group of early precursor lesions that are part of the low-grade pathway in breast cancer development. This concept implies that the neoplastic disease process begins at a stage much earlier than in situ carcinoma. We have performed a review of the published literature for the upgrade risk to ductal carcinoma in situ or invasive carcinoma in open biopsy after a diagnosis of ADH, FEA, or LN in core needle biopsy. This has revealed the highest upgrade risk for ADH (28.2% after open biopsy), followed by LN (14.9%), and FEA (10.2%). With LN, the pleomorphic subtype is believed to confer a higher risk than classical LN. With all types of precursor lesions, careful attention must be paid to the clinicopathological correlation for the guidance of the clinical management. Follow-up biopsies are generally indicated in ADH, and if there is any radiological-pathological discrepancy, also in LN or FEA.
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Affiliation(s)
| | - Zeinab Elsawaf
- Department of Pathology, University of Heidelberg, Germany
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24
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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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25
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Deshaies I, Provencher L, Jacob S, Côté G, Robert J, Desbiens C, Poirier B, Hogue JC, Vachon E, Diorio C. Factors associated with upgrading to malignancy at surgery of atypical ductal hyperplasia diagnosed on core biopsy. Breast 2010; 20:50-5. [PMID: 20619647 DOI: 10.1016/j.breast.2010.06.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 06/14/2010] [Accepted: 06/15/2010] [Indexed: 10/19/2022] Open
Abstract
Previous studies have shown that 4-54% of breast lesions reported on core biopsies as atypical ductal hyperplasia (ADH) are upgraded on further excision to ductal carcinoma in situ (DCIS) or invasive carcinoma. We evaluated the rate of upgrading ADH to carcinoma at surgery for ADH diagnosed by percutaneous biopsy, and examined characteristics associated with malignancy. We identified 13,488 consecutive biopsies conducted at one center over a nine-year period. A total of 422 biopsies with ADH in 415 patients were included. DCIS or invasive carcinoma was found in 132 cases (31.3% upgrading). Multivariate model revealed that ipsilateral breast symptoms, mammographic lesion other than microcalcifications alone, 14G core needle biopsy, papilloma co-diagnosis, severe ADH and pathologists with lower volume of ADH diagnosis were factors statistically associated with malignancy. However, no subgroups were identified for safe clinical-only follow-up. Surgery is recommended in all cases of ADH diagnosed by percutaneous breast biopsy.
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Affiliation(s)
- Isabelle Deshaies
- Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada.
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26
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Kohr JR, Eby PR, Allison KH, DeMartini WB, Gutierrez RL, Peacock S, Lehman CD. Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications. Radiology 2010; 255:723-30. [PMID: 20173103 DOI: 10.1148/radiol.09091406] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine if patients with fewer than three foci of atypical ductal hyperplasia (ADH) who have all of their calcifications removed after stereotactic 9- or 11-gauge vacuum-assisted breast biopsy (VABB) have a rate of upgrade to malignancy that is sufficiently low to obviate surgical excision. MATERIALS AND METHODS An institutional review board-approved, HIPAA-compliant retrospective review of 991 cases of consecutive 9- or 11-gauge stereotactic VABB performed during a 65-month period revealed 147 cases of atypia. One pathologist performed a blinded review of the results of procedures performed to assess for calcifications and confirmed ADH in 101 cases with subsequent surgical excision. Each large duct or terminal duct-lobular unit containing ADH was considered a focus and counted. Postbiopsy mammograms were reviewed to determine whether all calcifications were removed. Upgrade to malignancy was determined from excisional biopsy pathology reports. Upgrade rates as a function of both number of foci and presence or absence of residual calcifications were calculated and compared by using chi(2) tests. RESULTS Upgrade to malignancy occurred in 20 (19.8%) of the 101 cases. The upgrade rate was significantly higher in cases of three or more foci of ADH (15 [28%] of 53 cases) than in cases of fewer than three foci (five [10%] of 48 cases) (P = .02). Upgrade rates were similar, regardless of whether all mammographic calcifications were removed (seven [17%] of 41 cases) or all were not removed (nine [20%] of 45 cases) (P = .77). Upgrade occurred in two (12%) of 17 cases in which there were fewer than three ADH foci and all calcifications were removed. CONCLUSION The upgrade rate is significantly higher when ADH involves at least three foci. Surgical excision is recommended even when ADH involves fewer than three foci and all mammographic calcifications have been removed, because the upgrade rate is 12%.
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Affiliation(s)
- Jennifer R Kohr
- Department of Radiology, University of Washington Medical Center, Seattle, Wash., USA
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27
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Swamy R. Histological correlation of mammographically detected breast calcifications – A need for rational protocols. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.mpdhp.2009.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fehr MK. Limitations of minimally invasive breast biopsy. Recent Results Cancer Res 2009; 173:149-157. [PMID: 19763454 DOI: 10.1007/978-3-540-31611-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Mathias K Fehr
- Department of Obstetrics and Gynecology, Cantonal Hospital, Frauenfeld, Switzerland.
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Frequency and Upgrade Rates of Atypical Ductal Hyperplasia Diagnosed at Stereotactic Vacuum-Assisted Breast Biopsy: 9-Versus 11-Gauge. AJR Am J Roentgenol 2009; 192:229-34. [DOI: 10.2214/ajr.08.1342] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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30
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Eby PR, Ochsner JE, DeMartini WB, Allison KH, Peacock S, Lehman CD. Is Surgical Excision Necessary for Focal Atypical Ductal Hyperplasia Found at Stereotactic Vacuum-Assisted Breast Biopsy? Ann Surg Oncol 2008; 15:3232-8. [DOI: 10.1245/s10434-008-0100-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 07/09/2008] [Accepted: 07/10/2008] [Indexed: 11/18/2022]
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Hoang JK, Hill P, Cawson JN. Can mammographic findings help discriminate between atypical ductal hyperplasia and ductal carcinoma in situ after needle core biopsy? Breast 2007; 17:282-8. [PMID: 18063369 DOI: 10.1016/j.breast.2007.10.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 10/22/2007] [Accepted: 10/26/2007] [Indexed: 10/22/2022] Open
Abstract
In a screening population of women, the mammographic characteristics for 68 cases of atypical ductal hyperplasia (ADH) diagnosed by needle core biopsy (NCB) were reviewed to seek mammographic findings which differentiate between ductal carcinoma in situ (DCIS) and ADH. A blinded analysis by two radiologists was performed for 48 cases with microcalcification. The mammographic findings were correlated with the surgical histological results of benign non-atypical, ADH and carcinoma (DCIS or invasive) to identify features which were associated with a higher or lower odds ratio (OR) for malignancy. Underestimates for malignancy occurred in 14 of 29 cases with granular calcification form (OR 7.9, 95% confidence interval (CI) 1.5-41) and 6 of 8 cases with segmental/linear branching distribution (OR 9.0, 95%CI 1.6-52). No malignancy was found at surgical excision in 16 cases with fine, rounded calcification. In conclusion, detailed assessment of calcification distribution and form gave helpful predictors for malignancy. Lesions with fine rounded calcification were always benign.
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Affiliation(s)
- Jenny K Hoang
- St. Vincent's BreastScreen, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
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32
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Easley S, Abdul-Karim FW, Klein N, Wang N. Segregation of radiographic calcifications in stereotactic core biopsies of breast: is it necessary? Breast J 2007; 13:486-9. [PMID: 17760670 DOI: 10.1111/j.1524-4741.2007.00469.x] [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: 11/30/2022]
Abstract
Stereotactic-needle core biopsy (SNCB) is increasingly being used for the evaluation of mammographic calcifications. Radiography of SNCB specimens is essential to confirm the presence of calcifications within the biopsy material. To aid and direct the pathologist, it has been recommended that SNCBs be separated into those with and without radiographic calcifications and separately embedded. However, the utility of this separation to the pathologist has not been established. We reviewed 80 consecutive 11 gauge vacuum-assisted SNCB procedures performed for mammographic calcifications. The core biopsies were separated by the radiologist into those with and without radiographic calcifications ("calcs" and "no calcs"). Twenty-nine of 80 (36%) of the "calcs" cores were atypical or malignant, while 23 of 80 (29%) of the "no calcs" cores were atypical or malignant (chi(2) = 0.63, p = NS). The same diagnosis was rendered in the "calcs" and "no calcs" specimens in 61/80 cases (76%). Two cases of ductal carcinoma in situ, four cases of atypical ductal hyperplasia and 13 cases of fibroadenoma were diagnosed in the "calcs" cores only. However, in all cases where the pathologic lesion was seen in the "calcs" core only, the pathologic lesion was present on initial H&E levels and would have been diagnosed even in the absence of core segregation. Deeper sections were deemed necessary in seven of the 80 cases. No change in diagnosis was made on the basis of these deeper sections, even in the cases where histologic calcifications appeared on deeper sections. Separate embedding of SNCBs into those with and without radiographic calcifications does not appear to be of great utility to the pathologist. Equal attention should be given to all cores in the setting of SNCBs for mammographic calcifications.
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Affiliation(s)
- Samantha Easley
- Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA
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Holloway CMB, Saskin R, Brackstone M, Paszat L. Variation in the use of percutaneous biopsy for diagnosis of breast abnormalities in Ontario. Ann Surg Oncol 2007; 14:2932-9. [PMID: 17619931 DOI: 10.1245/s10434-007-9362-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Accepted: 11/15/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preoperative diagnosis of breast abnormalities is currently the standard of care. A population-based study to determine the use of percutaneous needle biopsy for breast diagnosis in Ontario was performed. METHODS A total of 17,068 women undergoing breast tissue sampling (percutaneous needle biopsy or surgical excision) for diagnosis between April 1, 2002, and December 31, 2002, and without a previous cancer diagnosis were identified. Univariate and multivariate analyses examined the association of age, residence in a particular local health integration network (LHIN), income quintile, urban or rural residence, primary care provider, any prior mammogram, and prior regular screening mammography, as well as whether the biopsy was initiated by a screening mammogram with different methods of tissue diagnosis. RESULTS A total of 10,459 women (61%) underwent percutaneous biopsy for diagnosis. A total of 10,131 women underwent surgery, of whom 6,637 received a benign diagnosis and 3,494 had cancer, for a benign-to-malignant ratio of 1.9:1. Women with cancer were slightly more likely to undergo percutaneous biopsy than women without (64.7% vs. 60.3%). There was variation among LHINs in the use of percutaneous biopsy (range, 24%-72%). Women with the highest incomes, urban residence, a primary care provider, or history of any prior mammography were more likely to receive percutaneous biopsy. On multivariate analysis, age 50 to 69 years, LHIN, urban residence, primary care provider, and screen-initiated evaluation were associated with percutaneous biopsy. CONCLUSIONS Variation in the use of percutaneous biopsy by factors unrelated to indications for biopsy indicate that strategies to identify and overcome barriers to its use are needed.
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Affiliation(s)
- Claire M B Holloway
- Department of Surgery, Division of Surgical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue T2-015, M4N 3M5, Ontario, Canada.
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Rutstein LA, Johnson RR, Poller WR, Dabbs D, Groblewski J, Rakitt T, Tsung A, Kirchner T, Sumkin J, Keenan D, Soran A, Ahrendt G, Falk JS. Predictors of Residual Invasive Disease after Core Needle Biopsy Diagnosis of Ductal Carcinoma In Situ. Breast J 2007; 13:251-7. [PMID: 17461899 DOI: 10.1111/j.1524-4741.2007.00418.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Core needle biopsy (CNB) is used to sample both mammographically and ultrasound detected breast lesions. A diagnosis of ductal carcinoma in situ (DCIS) by CNB does not ensure the absence of invasive cancer upon surgical excision and as a result an upstaged patient may need to undergo additional surgery for axillary nodal evaluation. This study evaluates the accuracy of CNB in excluding invasive disease and the preoperative features that predict upstaging of DCIS to invasive breast cancer. Two hundred fifty-four patients over an 8-year period from 1994 to 2002 with a diagnosis of DCIS alone by CNB were retrospectively reviewed. Underestimation of invasive cancer by CNB was determined. Radiographic, pathologic, and surgical features of the cohort were compared using univariate and multivariate analysis. The mean age was 55 years (range 27-84) and mean follow-up was 25 months with one patient unavailable for follow-up. There were a total of six patient deaths, all of which were not disease-specific. A total of 21 out of 254 patients (8%) with DCIS by CNB were upstaged to invasive cancer following surgical excision. There was a significant inverse relationship between the number of core biopsies and the incidence of upstaging (p < 0.006) in that patients with fewer core samples were more likely to be upstaged at surgical pathology. No relationship was noted between the size of the core samples and the likelihood of upstaging (p > 0.4). Of 21 patients with invasion, all but two had comedonecrosis by CNB. Comedonecrosis by CNB significantly increased the likelihood of upstaging (p < 0.001). Of the 21 patients who were upstaged, 12 required subsequent surgery for nodal evaluation while nine had sentinel node biopsy at initial operation. Finally, upstaged patients were significantly more likely to have a positive margin (p < 0.008). Ductal carcinoma in situ with comedonecrosis on CNB can help to predict the possibility of invasion. Increasing the number of core biopsies reduced the likelihood of sampling error.
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van Deurzen CHM, Hobbelink MGG, van Hillegersberg R, van Diest PJ. Is there an indication for sentinel node biopsy in patients with ductal carcinoma in situ of the breast? A review. Eur J Cancer 2007; 43:993-1001. [PMID: 17300928 DOI: 10.1016/j.ejca.2007.01.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 12/14/2006] [Accepted: 01/04/2007] [Indexed: 11/22/2022]
Abstract
Ductal carcinoma in situ (DCIS) of the breast is defined as a proliferation of malignant epithelial cells within breast ducts without evidence of invasion through the basement membrane. The detection rate of DCIS of the breast has dramatically increased since the mid-1980s as the result of the widespread use of screening mammography. DCIS currently represents about 15-25% of all breast cancers detected in population screening programmes. Although inherently a non-invasive disease, occult invasion with the potential of lymph node metastases may occur. Where performing an axillary lymph node dissection-or-not for DCIS used to be an important dilemma, the same now holds for the sentinel node biopsy. This article reviews the potential role of the sentinel node biopsy (SNB) in patients with DCIS. We conclude that based on the current literature, there is in general no role for a SNB in DCIS. A SNB should only be considered in patients with an excisional biopsy diagnosis of high risk DCIS (grade III with palpable mass or large tumour area by imaging) as well as in patients undergoing mastectomy after a core or excisional biopsy diagnosis of DCIS, although SNB may be contraindicated in many of the latter patients because of lesion size and/or multifocality. Even in these patients the value of a positive SN, containing mostly isolated tumour cells, is questionable.
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Affiliation(s)
- C H M van Deurzen
- Department of Pathology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Duijm LEM, Groenewoud JH, Roumen RMH, de Koning HJ, Plaisier ML, Fracheboud J. A decade of breast cancer screening in The Netherlands: trends in the preoperative diagnosis of breast cancer. Breast Cancer Res Treat 2007; 106:113-9. [PMID: 17219049 DOI: 10.1007/s10549-006-9468-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 11/25/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE In a prospective, multi-institutional follow-up study we describe the trends in the preoperative pathologic confirmation of breast cancer of women who underwent breast cancer screening between 1995 and 2005. METHODS We included all women aged 50-75 years who underwent biennial screening mammography in the southern breast cancer screening region of the Netherlands between February 13, 1995 and December 22, 2004. Clinical data, breast imaging reports, biopsy results and breast surgery reports were collected of all women with a positive screening result. Follow-up lasted through the next biennial screening examination and was approximately two years for all referred women. RESULTS Of 258,900 mammographic screening examinations, 3,064 (1.2%) were positive screens. The majority of women (92%) were analyzed in four regional hospitals and workup yielded breast cancer in 1,332 women. From 1995 to 2005, the percentage of breast cancer cases that underwent percutaneous biopsy prior to surgery, increased from 42.4 to 100%. The proportion of cancers with a preoperative diagnosis of malignancy by percutaneous biopsy, increased from 27.1% in 1995 to 92.7% in 2004. Preoperative breast cancer confirmation by fine needle aspiration cytology (FNAC) gradually decreased from 91.3% to 14.5%, whereas preoperative confirmation by ultrasound guided core biopsy (USCB) or stereotactic core needle biopsy (SCNB) increased from 8.7% to 69.1% and from 0 to 17.4% respectively. CONCLUSIONS A preoperative diagnosis of breast cancer is currently obtained in more than 90% of breast cancer patients. The increase in preoperative breast cancer diagnosis through 1995-2004 is correlated with the introduction of SNCB and increased use of USCB at the expense of FNAC.
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Affiliation(s)
- Lucien E M Duijm
- Department of Radiology, Catharina Hospital, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands.
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Fuhrman GM. Pro: SLNB in DCIS. Ann Surg Oncol 2006; 14:1005-6. [PMID: 17180481 DOI: 10.1245/s10434-006-9307-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 11/20/2006] [Accepted: 11/20/2006] [Indexed: 11/18/2022]
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Thompson M, Henry-Tillman R, Margulies A, Thostenson J, Bryant-Smith G, Fincher R, Korourian S, Klimberg VS. Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy. Ann Surg Oncol 2006; 14:148-56. [PMID: 17058127 DOI: 10.1245/s10434-006-9076-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 03/09/2006] [Accepted: 04/05/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Needle localization breast biopsy (NLBB) is presently the primary means of localizing non-palpable lesions. Disadvantages of NLBB include vasovagal episodes, patient discomfort, and miss rates. Because hematomas naturally fill the cavity after vacuum-assisted breast biopsies (VABB), we hypothesized that ultrasound (US) could be used to find and accurately excise the actual biopsy site of non-palpable breast lesions without a needle. METHODS This is a retrospective study from January 2000 to July 2005. Electronic chart review identified patients with non-palpable breast lesions detected by means of mammogram who then underwent lumpectomy via NLBB or the hematoma-directed ultrasound-guided technique (HUG). HUG involved localizing the hematoma with a 7.5-MHz US probe and using the "line of sight" technique straight down toward the chest wall. A block of tissue encompassing the hematoma was then excised. RESULTS Localization procedures were performed in 186 patients-63 (34%) via needle localization and 123 (66%) via HUG. The previous VABB site in 100% of patients was successfully excised using HUG, 65 of 123 (53%) were benign and 58 of 123 (47%) were malignant; margins were positive in 13 of these 58 (22%). NLBB was successful in 100% of patients, 44 of 63 (70%) were benign and 19 of 63 (30%) were malignant; margins were positive in 14 of these 19 (73%). Margin positivity was significantly higher for NLBB than HUG (P = 0.0001, Fisher Exact). CONCLUSIONS This study suggests that HUG is more accurate in localizing non-palpable lesions than NLBB. By eliminating the additional procedure needed for NLBB, HUG may also be more time- and cost efficient. HUG makes VABB not only a less invasive diagnostic procedure, but also a localization procedure.
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Affiliation(s)
- Margaret Thompson
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Mahoney MC, Robinson-Smith TM, Shaughnessy EA. Lobular Neoplasia at 11-Gauge Vacuum-Assisted Stereotactic Biopsy: Correlation with Surgical Excisional Biopsy and Mammographic Follow-Up. AJR Am J Roentgenol 2006; 187:949-54. [PMID: 16985141 DOI: 10.2214/ajr.05.0710] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the outcome of lobular neoplasia diagnosed at 11-gauge stereotactic vacuum-assisted biopsy (SVAB). MATERIALS AND METHODS Retrospective review of 1,819 lesions sampled with 11-gauge SVAB yielded 27 patients with lobular neoplasia as the most severe pathologic entity diagnosed. Patients with lobular neoplasia associated with atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS), or infiltrating carcinoma were excluded. Twenty patients underwent surgical excisional biopsy, and seven patients were followed mammographically for a mean of 52 months (range, 14-67 months). Mammographic lesion type, number of specimens obtained per lesion, and specific histologic features related to lobular carcinoma in situ (LCIS) were assessed. Results were compared with histologic findings at surgery or mammographic follow-up. RESULTS Nineteen lesions presented mammographically as microcalcifications, four as masses, three as masses with associated microcalcifications, and one as architectural distortion. A mean of 13 specimens were obtained per lesion. Carcinoma was found at surgical excision in 19% of the lesions (5/27). Lesions were upgraded to DCIS (n = 2), invasive lobular carcinoma (n = 2), and mixed invasive ductal and lobular carcinoma (n = 1). In addition to the diagnosis of lobular neoplasia at SVAB, one patient presented with synchronous infiltrating ductal carcinoma in the contralateral breast, and two patients developed metachronous infiltrating ductal carcinoma in a different quadrant of the ipsilateral breast. Twelve of the 27 lesions included LCIS. These lesions were evaluated pathologically to distinguish the classic (10/12) from the pleomorphic (2/12) form of this entity. Ten of the 12 LCIS cases underwent surgical excisional biopsy with four of the five upgrades occurring in these patients. Only one of these patients was shown to have the pleomorphic type of LCIS. Lesions in seven patients who underwent mammographic follow-up remained stable. CONCLUSION The known association of lobular neoplasia with high-risk and malignant lesions at surgical biopsy requires careful consideration when lobular neoplasia is diagnosed as the most severe histologic entity at SVAB. The diagnosis of lobular neoplasia at 11-gauge SVAB is not reliable in view of the 19% upgrade rate at the time of surgical excisional biopsy in our study. No predictive mammographic features allowed distinction between the patients with lesions that were upgraded at the time of surgery from those whose lesions were not upgraded.
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Affiliation(s)
- Mary C Mahoney
- Department of Radiology, University of Cincinnati, 234 Goodman St., M.L. 772, Cincinnati, OH 45267, USA
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Wu YC, Chen DR, Kuo SJ. Personal experience of ultrasound-guided 14-gauge core biopsy of breast tumor. Eur J Surg Oncol 2006; 32:715-8. [PMID: 16769196 DOI: 10.1016/j.ejso.2006.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 04/20/2006] [Indexed: 10/24/2022] Open
Abstract
AIM This study was aimed to examine the efficacy of ultrasound-guided core needle biopsy of breast tumor and compared with the results of previous publications. METHODS From January 2001 to September 2003, 546 lesions in 513 consecutive patients with the identification of a tumor on ultrasound examination categorized belong and above C3 according to BIRADS (Breast Image Reporting and Data Systems). A minimum of three samples was taken during the biopsy process. RESULTS The patients' ages ranged from 17 to 89 years (mean, 43 years); tumors were from 5.7 to 41.6 mm in diameter (mean, 20.3 mm). There were 341 lesions with benign findings, 202 lesions with malignancy and 3 lesions with atypical ductal hyperplasia (ADH). Underestimates were found in five patients. Two patients were "ADH-DCIS (ductal carcinoma in situ) underestimate", and three patients were "DCIS-IDC (invasive ductal carcinoma) underestimate". The ADH underestimation rate was 40% (2/5) and DCIS underestimation rate was 43% (3/7). No false-positive results were observed. According to this study, the accuracy rate was 99%, sensitivity rate 97.6%, specificity rate 100%, and false-negative rate 2.4%. CONCLUSIONS Both palpable and impalpable breast lesions should be examined under image guidance and automated core biopsy is the technique of first choice. Fourteen-gauge core biopsy can provide a definitive diagnosis in 99% of solid tumors in this series.
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Affiliation(s)
- Y-C Wu
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 500, Taiwan
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Abstract
The increasingly large proportion of elderly women in the United States population carries a disproportionate burden of breast cancer. The advent of minimally invasive surgical techniques applicable to breast disease has brought new opportunities to diagnose and treat breast cancer in the older population. This article reviews issues important to the evolving field of breast cancer management in older women: cancer risk and screening considerations, diagnosis and biopsy approaches, and surgical treatment options based on current studies and recommendations.
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Affiliation(s)
- Barbara J Messinger-Rapport
- Cleveland Clinic Lerner College of Medicine and Section of Geriatric Medicine, Department of General Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A91, Cleveland, OH 44195, USA.
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Ciatto S, Houssami N, Ambrogetti D, Bianchi S, Bonardi R, Brancato B, Catarzi S, Risso GG. Accuracy and Underestimation of Malignancy of Breast Core Needle Biopsy: the Florence Experience of Over 4000 Consecutive Biopsies. Breast Cancer Res Treat 2006; 101:291-7. [PMID: 16823506 DOI: 10.1007/s10549-006-9289-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 05/24/2006] [Indexed: 11/26/2022]
Abstract
Breast core needle biopsy (CNB) is used for sampling breast lesions in both the screening and diagnostic context. We present the accuracy of breast CNB from a consecutive series of 4035 core biopsies, using methods that minimise selection and verification bias. We calculate accuracy and underestimation of malignancy for both automated (14G) and directional vacuum-assisted (11G) CNB performed under stereotactic or sonographic guidance. Overall sensitivity of CNB is 94.2% (92.9-95.5%) and specificity is 88.1% (86.6-89.6%), positive and negative predictive values are 84.8% (82.9-86.7%) and 95.6% (94.6-96.6%), respectively. In sampling microcalcification, the overall underestimation of malignancy is 26.6% (22.9-30.3%): underestimation is significantly higher for automated CB relative to VAB (chi2 ((df = 1)) = 8.90 , P = 0.002), the absolute difference in underestimation being 14% (5-23%); sensitivity is higher for VAB than automated CB (chi2 ((df = 1)) = 3.28, P = 0.06) but specificity is significantly higher for automated CB (14G) relative to VAB (11G) (chi2 ((df = 1)) = 6.37, P = 0.01), and the overall accuracy of the two methods is similar. Sensitivity of CNB improved with experience (over time and in relation to caseload). Accuracy was not substantially affected by lesion palpability or image-guidance method, and was similar for both masses and calcification but lower for lesions depicted as distortions on mammography. Inadequacy was very low and decreased with greater operator caseload, and was not associated with core gauge or image-guidance method. False negatives occurred in 4.4% (3.4-5.4%) of cases, and where core histology was benign but discordant with (suspicious) imaging and/or clinical findings the likelihood of malignancy was 33.1% (18.5-47.7%), emphasising the importance of correlating all test information in breast diagnosis.
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Affiliation(s)
- Stefano Ciatto
- Centro per lo Studio e la Prevenzione Oncologica (CSPO), Florence, Italy
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Dillon MF, Hill ADK, Quinn CM, O'Doherty A, McDermott EW, O'Higgins N. The accuracy of ultrasound, stereotactic, and clinical core biopsies in the diagnosis of breast cancer, with an analysis of false-negative cases. Ann Surg 2005; 242:701-7. [PMID: 16244544 PMCID: PMC1409862 DOI: 10.1097/01.sla.0000186186.05971.e0] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Preoperative core biopsy in breast cancer is becoming the standard of care. The aim of this study was to analyze the various methods of core biopsy with respect to diagnostic accuracy and to examine the management and outcome of those patients with false-negative biopsies. METHODS All patients undergoing core biopsy for breast abnormalities over a 5-year period (1999-2003) were reviewed. The accuracy rates for each method of core biopsy, the histologic agreement between the core pathology and subsequent excision pathology, and the length of follow-up for cases of benign disease were studied. Patients whose biopsies were benign but who were subsequently diagnosed with cancer underwent detailed review. RESULTS There were 2427 core biopsies performed over the 5-year period, resulting in a final diagnosis of cancer in 1384 patients, benign disease in 954 patients, and atypical disease in 89 patients. Biopsy type consisted of 1279 ultrasound-guided cores, 739 clinically guided cores, and 409 stereotactic-guided cores. The overall false-negative rate was 6.1%, with specific rates for ultrasound-, clinical-, and stereotactic-guided cores of 1.7%, 13%, and 8.9%, respectively. False-negative biopsies occurred in 85 patients, and in 8 of these patients the diagnosis was delayed by greater than 2 months. In all other false-negative cases, "triple assessment" review allowed prompt recognition of discordant biopsy results and further evaluation. CONCLUSION Ultrasound guidance should be used to perform core biopsies in evaluating all breast abnormalities visible on ultrasound. Adherence to principles of triple assessment following biopsy allows for early recognition of the majority of false-negative cases.
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Affiliation(s)
- Mary F Dillon
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
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Frede TE. Opportunistic breast cancer early detection in Tyrol, Austria 1996–2004. Eur J Radiol 2005; 55:130-8. [PMID: 15925467 DOI: 10.1016/j.ejrad.2005.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Revised: 03/18/2005] [Accepted: 04/04/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE Evaluate the need for a mammography-screening program for Tyrol, as recently proposed in an OBIG feasibility study commissioned by the Austrian Ministry for Health and Women, in view of the already existing organized opportunistic screening. MATERIALS AND METHODS This author has examined the state of breast cancer early detection and diagnosis in Tyrol. A comprehensive review of all available data and results based on 3340 primary biopsy recommendations between 1996 and 2004 at our breast centre was performed. RESULTS Early detection has been improved by organizing the existing opportunistic screening through a true team approach, incorporating not only the clinic's specialties, but also the private radiologists and referring physicians. In 2004, our centre made the definitive diagnosis in 230 (67.6%) of the about 340 primary breast cancer cases occurring yearly in Tyrol with 62.2% being discovered by routine examination and 74.3% stemming from second opinion examinations. About 92.4% of our primary biopsies are performed minimally invasive with an overall 42.9% (1375 of 3205 cases) malignancy rate. Pathological TNM-staging was obtained in over 95% of women under 70 years of age. On average 55.3% (62.0% in 2004) of all discovered cancers were TNM-stage 1 or better lesions (76.2% in our routine patients). With an overall participation of about 75% of our target group (women over 34 years), it is women under the age of 50 years, who most consistently follow our recommendations, resulting in an above average rate of 58.5% TNM-stage 1 and better lesions for all discovered breast cancers (routine and symptomatic) in this group. CONCLUSIONS Opportunistic screening with a true team approach, combined with minimally invasive diagnosis and a strive for excellence have resulted in improved diagnosis, ever expanding patient and referring physician acceptance and an increase of positive prognostic factors, which eclipses the results of any published international mammography-screening program. A program as proposed by the OBIG would only represent one giant leap backwards for Tyrolean womankind!
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Affiliation(s)
- Thomas E Frede
- BrustGesundheitZentrumTirol, Universitätsklinik für Radiodiagnostik Radiologie II, University of Innsbruck, A-6020 Innsbruck, Austria.
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Weaver DL, Vacek PM, Skelly JM, Geller BM. Predicting Biopsy Outcome After Mammography: What Is the Likelihood the Patient Has Invasive or In Situ Breast Cancer? Ann Surg Oncol 2005; 12:660-73. [PMID: 15968496 DOI: 10.1245/aso.2005.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2004] [Accepted: 04/03/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND As many as 1,000,000 breast biopsies are performed annually in the United States. Although substantial effort has been devoted to estimating breast cancer risk, there have been no studies to predict outcome in women undergoing breast biopsy. METHODS A population-based study was undertaken to develop and test models for predicting the probability of invasive breast cancer and/or ductal carcinoma-in-situ in 7670 women undergoing breast biopsy after mammography. Logistical prediction models were developed by using data from 6129 randomly selected women and tested with data from the remaining women. RESULTS The overall cancer prevalence among women undergoing biopsy was 22.4%. Prevalence in women with mammograms highly suggestive of malignancy (category 5) was 84.6%, with minimal variation in individual cancer probabilities due to age. A total of 24.6% of women with suspicious mammograms (category 4) had cancer, but individual probability estimates ranged from .01 to .86, depending on age, presence of a lump, previous biopsy, menopausal status, and use of postmenopausal hormone therapy. These variables also influenced biopsy outcome in women with other mammography assessments (categories 0-3), but the overall prevalence was lower (8.6%), and estimated probabilities ranged from .01 to .45. When cancer was present, the probability of invasive disease was influenced by mammogram assessment category, absence of mammogram calcifications, and presence of a lump. CONCLUSIONS The probabilities of invasive cancer and ductal carcinoma-in-situ in women undergoing biopsy can be more accurately predicted by using clinical characteristics in addition to mammography findings. This information could potentially influence decisions regarding immediate biopsy or continued surveillance.
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Affiliation(s)
- Donald L Weaver
- Department of Pathology, University of Vermont College of Medicine and Vermont Cancer Center, Health Science Complex, 89 Beaumont Avenue, Burlington, Vermont 05405-0068, USA.
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Wong TT, Cheung PSY, Ma MKK, Lo GG. Experience of Stereotactic Breast Biopsy Using the Vacuum-assisted Core Needle Biopsy Device and the Advanced Breast Biopsy Instrumentation System in Hong Kong Women. Asian J Surg 2005; 28:18-23. [PMID: 15691792 DOI: 10.1016/s1015-9584(09)60252-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Stereotactic breast biopsy of non-palpable lesions using the vacuum-assisted core needle biopsy (CNB) device and the large core excision biopsy system is a reliable biopsy method when compared with open biopsy. Its use in Western countries is well accepted. This study aimed to assess the feasibility and results of using these systems to perform stereotactic biopsy in Asian women. METHODS A total of 114 patients with non-palpable mammographic lesions underwent stereotactic breast biopsy using the vacuum-assisted CNB device and the large core excision biopsy system between November 1999 and December 2002. The indications for biopsy were mammographic abnormalities considered indeterminate or suspicious that were not palpable or visible on ultrasound. The methods adopted for biopsy in Asian women were reviewed and the results including the final pathology, complications, scarring and acceptance by patients were recorded. RESULTS Stereotactic breast biopsy was performed using the vacuum-assisted CNB device in 107 patients and the large core excision biopsy system in seven patients. Of those who underwent biopsy using the vacuum-assisted CNB device, 15 (14%) had moderate to severe bleeding during the procedure and seven (6.5%) had severe bruising afterwards. Carcinoma was detected in 31 of the 114 patients (27.2%). CONCLUSION Although Asian women in general have smaller and denser breasts than their Western counterparts, stereotactic breast biopsy using the vacuum-assisted CNB device and the large core excision biopsy system was feasible with modification of the individual steps during the procedure. Our results are comparable with those published previously and the procedure was well accepted by patients.
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Affiliation(s)
- Ting-Ting Wong
- Breast Care Centre, Hong Kong Sanatorium and Hospital, 9/F Li Shu Pui Block, 2 Village Road, Happy Valley, Hong Kong SAR, China
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Farshid G, Rush G. Assessment of 142 Stellate Lesions With Imaging Features Suggestive of Radial Scar Discovered During Population-based Screening for Breast Cancer. Am J Surg Pathol 2004; 28:1626-31. [PMID: 15577683 DOI: 10.1097/00000478-200412000-00012] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Because some lesions diagnosed as radial scars (RS) on core biopsy have been found to be malignant on excision, core biopsy has not had an established role in the assessment of RS. In our breast cancer-screening program, we have avoided core biopsy if RS is suspected on imaging. Recently, two reports have expanded the experience with core biopsy of RS, prompting this review of our assessment protocols for lesions suspected as being RS. Between January 1996 and January 2003, stellate lesions with imaging features of RS in which core biopsy was omitted because of a presumptive radiologic diagnosis of RS are included. Demographic, radiologic, and cytologic data were correlated with the histologic findings in the excised specimen. On imaging, 9% (142) of all stellate lesions were suspected to be RS. Only 66.2% (94) were confirmed as RS on histology; 38 cases (28.6%) were carcinomas (36 invasive, 2 in situ) and 7% showed benign fibrocystic changes; 87.1% of the carcinomas required further surgery for positive margins. Axillary staging was also needed for the invasive cancers. Among the histologically proven RS, 28 of 94 (29.8%) showed areas of atypical ductal hyperplasia, lobular neoplasia, ductal carcinoma in situ, or invasive carcinoma. These proliferations were typically focal and unpredictable and were usually completely excised by the initial diagnostic biopsy. Core biopsy would be valuable in the assessment of lesions with imaging features suggestive of RS since 28.6% of such lesions are indeed carcinomas that mimic RS. Identification of these cancers would permit one stage breast and axillary surgery to be planned. The policy of mammographic surveillance for lesions with nonmalignant core biopsies remains controversial because of the paucity of data. Ongoing evaluation is needed as more experience is reported.
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Affiliation(s)
- Gelareh Farshid
- BreastScreen SA, Division of Tissue Pathology, Institute of Medical and Veterinary Science, Adelaide, South Australia.
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Burak WE, Agnese DM, Povoski SP. Advances in the surgical management of early stage invasive breast cancer. Curr Probl Surg 2004. [DOI: 10.1067/j.cpsurg.2004.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Fuhrman GM. Sentinel Lymph Node Mapping and Biopsy for Ductal Carcinoma in situ and Other Controversial Indications. Am Surg 2004. [DOI: 10.1177/000313480407000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review discusses the currently available literature regarding three controversial indications for sentinel node mapping for breast cancer patients. For women with ductal carcinoma in situ (DCIS), the use of sentinel lymph node mapping (SLNM) should be limited to women having a mastectomy. For patients with multifocal breast carcinoma, SLNM is accurate when a retroareolar injection technique is employed in the procedure. When treatment plans for node-negative patients call for neoadjuvant chemotherapy, accurate sentinel node mapping can be performed prior to the administration of chemotherapy. The resolution of these and other controversies should result in the expansion of the number of patients evaluated with SLNM in the future.
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Affiliation(s)
- George M. Fuhrman
- From the Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
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Hemmer PHJ, Klaase JM, Mastboom WJB, Gerritsen JJGM, Mulder HJ, Volker EDP. The continued utility of needle localised biopsy for non-palpable breast lesions. Eur J Surg Oncol 2004; 30:10-4. [PMID: 14736516 DOI: 10.1016/j.ejso.2003.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To analyse the results of needle localised biopsy (NLB) for non-palpable breast lesions in our hospital and to compare them with data on stereotactic large-core biopsy (SCB), which has been recently introduced as a new less invasive method for evaluating mammographic abnormalities. METHODS We evaluated the results of all consecutive NLB procedures in our hospital in the period 1998-2000 and compared them with data from literature. Clinical, mammographic and pathological data were reviewed. RESULTS In the present study 314 patients with 319 non-palpable mammographic abnormalities were included. Seventy percent of patients were referred to us from the national screening program. In all but one patient the NLB procedure was successful. The mean duration of hospital stay was 3 (1-10) days. Histological diagnosis was invasive carcinoma in 31%, invasive carcinoma with DCIS in 32%, DCIS alone in 13% and benign in 24%. The invasive carcinoma group scored tumour-free margins after the first operation in 77% of patients, for both the DCIS with invasive carcinoma group and DCIS alone group the tumour-free margin rate was 47%. Patients with invasive carcinoma and/or DCIS were re-operated in 88%. Of all procedures, 91% was performed without complications. CONCLUSION NLB is a safe, relatively simple procedure with a high diagnostic accuracy combined with a lower failure and false-negative rate compared to SCB.
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Affiliation(s)
- P H J Hemmer
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
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