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Chen Z, Salibay C, Elatre W, Naritoku WY, Ma Y, Martin SE, Wang T. Performance of breast fine needle aspiration as an initial diagnostic tool: A large academic hospital experience. Cytopathology 2022; 33:707-715. [PMID: 35869577 PMCID: PMC9826159 DOI: 10.1111/cyt.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The clinical performance of the Yokohama reporting system for breast cytology remains uncertain. METHODS In this study, we retrospectively evaluated 318 breast fine needle aspirations (FNABs) from Los Angeles County Hospital over a five-year period, analysing data for breast cytology, histology, and radiology. RESULTS Among 318 breast FNAB cases, 78.3% (249/318) were benign and 5.3% (17/318) malignant. Of 83 cases with follow-up histology, 14.5% (12/83) were insufficient, 66.3% (55/83) were benign, and 16.9% (17/83) were malignant. Of 55 benign cases, 61.8% (34/55) were fibroadenoma and 9 (9/55, 16.4%) were fibrocystic changes. Two cases were diagnosed as "atypical" but confirmed "benign" on core needle biopsy (CNB). No "suspicious" cases were found. Seventeen malignant cases were confirmed by CNB, including 70.6% (12/17) invasive ductal carcinoma, 11.8% (2/17) invasive lobular carcinoma, and one malignant phyllodes tumour. Receptor studies on cell blocks of three malignant cases showed concordant results with CNB results. In addition, 82.2% (148/180) of lesions with Breast Imaging-Reporting and Data System (BI-RADS) scores of 2 or 3 were benign and 92.3% (12/13) BI-RADS score 5 lesions were malignant on FNAB. Finally, 90% (67/74) of BI-RADS 4a lesions were benign, and 97% (36/37) of fibroadenomas were BI-RADS score 4a. CONCLUSION This, by far the largest U.S. breast cytology study, showed 93.3% sensitivity, 100% specificity, 100% positive predictive value, and 98.2% negative predictive value for breast FNAB. Women with breast lesions of BI-RADS score 3 or less have a low risk of malignancy; FNAB would contribute to the reduction of excisional biopsies. FNAB can be considered as an initial diagnostic tool for BI-RADS 4 mass/lesions and satellite lesions, as well as for triaging patients.
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Affiliation(s)
- Zhengshan Chen
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
| | - Christine Salibay
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
| | - Wafaa Elatre
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
| | - Wesley Y. Naritoku
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
| | - Yanling Ma
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
| | - Sue Ellen Martin
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
| | - Tiannan Wang
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
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Rajendran K, Sudalaimuthu M, Ganapathy S. Cytological Grading of Breast Carcinomas and Its Prognostic Implications. Cureus 2022; 14:e29385. [PMID: 36304360 PMCID: PMC9585361 DOI: 10.7759/cureus.29385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Determining the histological grade of breast carcinomas before mastectomy is necessary to decide about neoadjuvant chemotherapy. Core needle biopsies used for this purpose often under-grade the tumour. The grade obtained from fine needle aspiration cytology samples will help in such situations and whenever biopsy is not done, as in a resource-poor setup. Many studies are being done to find out the cytological grading system that correlates well with histological grading. Methods This study was done between 2016 and 2019 including the cases in which both modified radical mastectomy and fine needle aspiration of the tumour had been done. Robinson’s cytological grading was done in Papanicolaou and haematoxylin & eosin (H&E) stained cytology smears and correlated with modified Bloom-Richardson histologic grading done in modified radical mastectomy specimens. We also studied the prognostic significance of Robinson’s method by studying the association between cytological grade and lymph node metastasis. Results Sixty cases were studied. The two methods had the same grade in 49 (81.7%) cases. They showed a significant positive correlation (Spearman correlation coefficient 0.848, p-0.0001), significant association (Chi-square test, p-0.0001), and substantial agreement (kappa value 0.72). Multiple regression analysis showed chromatin score and nucleoli score as the most influential parameters. Lymph node metastasis showed significant association with cytological grade (p-0.0003), cell dissociation score (p-0.0001), nucleoli score (p-0.01), and chromatin score (p-0.04). Conclusion Robinson’s cytological grading is a simple, reliable adjunct/alternative to core needle biopsies for grading breast carcinomas before mastectomy. Hence, it can be made a part of routine cytology reporting of breast carcinomas. Further long-term studies will help in confirming its prognostic significance.
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Gan Q, Roy-Chowdhuri S. Small but powerful: the promising role of small specimens for biomarker testing. J Am Soc Cytopathol 2020; 9:450-60. [PMID: 32507626 DOI: 10.1016/j.jasc.2020.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 12/22/2022]
Abstract
Emphasis on the use of small specimens for biomarker testing to provide prognostic and predictive information for guiding clinical management for patients with advanced-stage cancer has been increasing. These biomarker tests include molecular analysis, cytogenetic tests, and immunohistochemical assays. Owing to the limited nature of the cellular material procured in these small specimens, which are collected using minimally invasive techniques (ie, fine needle aspiration and core needle biopsy), pathologists have been required to triage these samples judiciously and provide the clinically relevant genomic information required for patient care. Awareness of the advantages and limitations of these specimen preparations and the specific preanalytic requirements for the testing methods will help pathologists to develop optimal strategies to maximize the chances of effectively using these samples for comprehensive diagnostic and relevant biomarker testing.
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Alwahaibi N, Alghallabi A, Alsinawi S, Aldairi N. Cytological Smear and Cell Block Versus Tissue Biopsies in the Diagnosis of Malignant Tumours in Non-Gynaecologic Specimens. Ethiop J Health Sci 2019; 28:583-588. [PMID: 30607073 PMCID: PMC6308769 DOI: 10.4314/ejhs.v28i5.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Cytological smear and cell block (CB) are routinely used to diagnose non-gynaecologic specimens. However, there is scanty information in the literature to compare cytological smear and CB with the corresponding tissue biopsies. This study is aimed at evaluating the accuracy of cytological smear and CB in the diagnosis of malignant tumours in non-gynaecologic specimens. Materials and Methods A total of 70 malignant cases were subjected to cytological smear and CB. Corresponding histopathology was also included. The most frequent immunomarkers found between CB and tissue biopsies were also correlated. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false positive and false negative values were analyzed for each method. Results The accuracy, sensitivity and positive predictive value for cytological smear were 92.8%, 100.0% and 92.9%, whereas for CB were 91.4%, 98.4% and 92.7%, respectively. In CB method, the accuracy, sensitivity and positive predictive value for CK7 were 88.9%, 91.7% and 95.6%, whereas for CK5/6 were 75%, 100% and 57.1%, respectively. Conclusion Cytological smear and CB are very sensitive and accurate in the detection of malignant tumours in nongynaecologic specimens. Additional corresponding tissue biopsies should be re-evaluated.
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Affiliation(s)
- Nasar Alwahaibi
- Department of Allied Health Sciences, Sultan Qaboos University
| | | | | | - Najat Aldairi
- Department of Pathology, Sultan Qaboos University Hospital
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Fader AN, Bergstrom J, Jernigan A, Tanner EJ, Roche KL, Stone RL, Levinson KL, Ricci S, Wethingon S, Wang TL, Shih IM, Yang B, Zhang G, Armstrong DK, Gaillard S, Michener C, DeBernardo R, Rose PG. Primary cytoreductive surgery and adjuvant hormonal monotherapy in women with advanced low-grade serous ovarian carcinoma: Reducing overtreatment without compromising survival? Gynecol Oncol 2017; 147:85-91. [PMID: 28768570 DOI: 10.1016/j.ygyno.2017.07.127] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Women with advanced-stage, low-grade serous ovarian carcinoma (LGSC) have low chemotherapy response rates and poor overall survival. Most LGSC tumors overexpress hormone receptors, which represent a potential treatment target. Our study objective was to determine the outcomes of patients with advanced-stage LGSC treated with primary cytoreductive surgery (CRS) and hormone therapy (HT). METHODS A retrospective study was performed at two academic cancer centers. Patients with Stage II-IV LGSC underwent either primary or interval CRS followed by adjuvant HT between 2004 and 2016. Gynecologic pathologists reviewed all cases. Two-year progression-free (PFS) and overall survival (OS) were calculated. RESULTS Twenty-seven patients were studied; primary CRS followed by HT were administered in 26, while 1 patient had neoadjuvant chemotherapy followed by CRS and HT. The median patient age was 47.5, and patients had Stage II (n=2), Stage IIIA (n=6), Stage IIIC (n=18), and Stage IV (n=1) disease. Optimal cytoreduction to no gross residual was achieved in 85.2%. Ninety six percent of tumors expressed estrogen receptors, while only 32% expressed progesterone receptors. Letrozole was administered post operatively in 55.5% cases, anastrozole in 37.1% and tamoxifen in 7.4%. After a median follow up of 41months, only 6 patients (22.2%) have developed a tumor recurrence and two patients have died of disease. Median PFS and OS have not yet been reached, but 2-year PFS and OS were 82.8% and 96.3%, respectively, and 3-year PFS and OS were 79.0% and 92.6%, respectively. CONCLUSIONS Our series describes the initial experience with cytoreductive surgery and hormonal monotherapy for women with Stage II-IV primary ovarian LGSC. While surgery remains the mainstay of treatment, chemotherapy may not be necessary in patients with advanced-stage disease who receive adjuvant hormonal therapy. A cooperative group, Phase III trial is planned to define the optimal therapy for women with this ovarian carcinoma subtype.
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Affiliation(s)
- Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Jennifer Bergstrom
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amelia Jernigan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Edward J Tanner
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kara Long Roche
- Department of Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rebecca L Stone
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kimberly L Levinson
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Stephanie Ricci
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie Wethingon
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tian-Li Wang
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ie-Ming Shih
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bin Yang
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Gloria Zhang
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Deborah K Armstrong
- Sidney Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Stephanie Gaillard
- Sidney Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chad Michener
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Robert DeBernardo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Peter G Rose
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
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Al Nemer A. Combined Use of Unguided FNA and CNB Increases the Diagnostic Accuracy for Palpable Breast Lesions. Diagn Cytopathol 2016; 44:578-81. [PMID: 27079464 DOI: 10.1002/dc.23484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/23/2016] [Accepted: 03/30/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Obtaining nonsurgical precise diagnosis of a palpable breast lesion is of paramount importance. Both core needle biopsy (CNB) and fine needle aspiration (FNA) are validated techniques used for this purpose. In this study, we compared the accuracy of both methods and explored whether combining both tests adds significant diagnostic value, and for the first time, we tested the concordance of tumor grading in parallel biopsies with reference to surgical excision (SE). METHODS Patients underwent concurrent unguided FNA and CNB followed by SE were retrospectively recruited. Chi-square was used to compare the accuracy of malignancy detection, and tumor grade agreement was calculated using kappa (k) statistical test with reference to SE findings. RESULTS All patients were females (n: 170). The median age was 45 years. Excluding 18 cases which had inadequate FNA, accuracy of FNA and CNB was 86.2% and 79.6%; respectively. Accuracy was 94.1% when we considered both tests together for any positive result. For tumor grading, the agreement was 91.6% for CNB and 98.8% for FNA. CONCLUSION Diagnostic strength was comparable for both FNA and CNB, slightly more favorable for the former. Combination of both tests significantly minimized missing cases as false negative. When available, it is worthy to grade malignant FNA samples. Diagn. Cytopathol. 2016;44:578-581. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Areej Al Nemer
- Department of Surgical Pathology, University of Dammam, Saudi Arabia
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