OBJECTIVE To evaluate core needle biopsy (CNB) as a mini-mally invasive method to examine breast lesions and discuss theclinical significance of subsequent immunohistochemistry (IHC)analysis.METHODS The clinical data ...OBJECTIVE To evaluate core needle biopsy (CNB) as a mini-mally invasive method to examine breast lesions and discuss theclinical significance of subsequent immunohistochemistry (IHC)analysis.METHODS The clinical data and pathological results of 235 pa-tients with breast lesions, who received CNB before surgery, wereanalyzed and compared. Based on the results of CNB done beforesurgery, 87 out of 204 patients diagnosed as invasive carcinomawere subjected to immunodetection for p53, c-erbB-2, ER and PR.The morphological change of cancer tissues in response to chemo-therapy was also evaluated.RESULTS In total of 235 cases receiving CNB examination, 204were diagnosed as invasive carcinoma, reaching a 100% consistentrate with the surgical diagnosis. Sixty percent of the cases diag-nosed as non-invasive carcinoma by CNB was identified to havethe presence of invading elements in surgical specimens, and simi-larly, 50% of the cases diagnosed as atypical ductal hyperplasia byCNB was confirmed to be carcinoma by the subsequent result ofexcision biopsy. There was no significant difference between theCNB biopsy and regular surgical samples in positive rate of im-munohistochemistry analysis (p53, c-erbB-2, ER and PR; P >0.05).However, there was significant difference in the expression rate ofp53 and c-erbB-2 between the cases with and without morphologi-cal change in response to chemotherapy (P < 0.05). In most caseswith p53 and c-erbB-2 positive, there was no obvious morphologi-cal change after chemotherapy.CONCLUSION CNB is a cost-effective diagnostic method withminimal invasion for breast lesions, although it still has some limi-tations. Immunodetection on CNB tissue is expected to have greatsignificance in clinical applications.展开更多
Objective: Axillary lymph node status is one of the most important prognostic indicator of survival for breast cancer, especially in ductal carcinoma in situ(DCIS). The purpose of this study was to investigate whether...Objective: Axillary lymph node status is one of the most important prognostic indicator of survival for breast cancer, especially in ductal carcinoma in situ(DCIS). The purpose of this study was to investigate whether sentinel lymph node biopsy(SLNB) should be performed in patients with an initial diagnosis of DCIS. Methods: A retrospective study was performed of 124 patients with an initial diagnosis of DCIS between March 2000 and June 2014. The patients were treated with either SLNB or axillary node dissection during the surgery, and we compared the clinicopathologic characteristics, image features, and immunohistochemical results. Results: Eighty-two patients(66.1%) had pure DCIS and 25(20.2%) had DCIS with microinvasion(DCISM), 17(13.7%) updated to invasive breast cancer(IBC). 115 patients(92.7%) underwent SLNB, among them, 70 patients(56.5%) underwent axillary node dissection. 3 of 115 patients(2.6%) had a positive sentinel lymph node, only 1(1.4%) of 70 patients had axillary lymph node metastasis, in 84 patients(66.7%) who were diagnosed DCIS by core needle biopsy(CNB) and vacuum-assisted biopsy(VAB). 26 patients(31.0%) were upstaged into IBC or DCISM in the final histological diagnosis. The statistically significant factors predictive of underestimation were large tumor size, microcalcifications, comedo necrosis, positive Her-2 status, negative estrogen receptor status. Conclusion: The metastasis of sentinel lymph nodes in pure DCIS is very low, but the underestimation of invasive carcinoma in patients with an initial diagnosis of DCIS is an usual incident, especially in the cases when DCIS is diagnosed by CNB or VAB. Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with large tumor sizes, microcalcifications, comedo necrosis, positive Her-2 status, negative ER status are more likely to be DCISM and IBC in final diagnosis. SLNB should be performed in this part of patients.展开更多
Aims: The reproducibility of Ki-67 between core-needle biopsies and surgical materials has not been well documented in the literature, although the concordance affects the utility of the Ki-67 labeling index based on ...Aims: The reproducibility of Ki-67 between core-needle biopsies and surgical materials has not been well documented in the literature, although the concordance affects the utility of the Ki-67 labeling index based on the core-needle biopsy materials, which indicates the need for preoperative chemotherapy. The aim of this study was to reveal the reproducibility of Ki-67 between both materials and the cause of discrepancies. Methods and Results: We analyzed 137 cases of invasive carcinoma of the breast and the compared Ki-67-labeling index between core-needle biopsy and surgical materials. The Ki-67-labeling index of biopsy and surgical specimens ranged from 1% to 85% (median: 13%) and 1% to 80% (median: 12%), respectively. The discrepancy of Ki-67-labeling ranged from 0% to 55% (median: 4%) and could be calculated by the tumor size, hot spots of surgical materials, a high Ki-67-labeling index based on the core-needle biopsy materials, and the total length of core needles, respectively. Conclusions: The concordance rate of the Ki-67-labeling index between core-needle biopsies and surgical materials was favorable, so we can use each Ki-67-labeling index of core-needle biopsies as a marker for preoperative chemotherapy. Factors affecting the index discrepancy were hot spots, a high Ki-67-labeling index, and the total length of biopsy material. Judgements on the subtypes and clinical procedures of invasive breast carcinoma could be made comprehensively based on not only the Ki-67-labeling index but also the existence of hot spots and histological grade.展开更多
Ultrasound (US)-guided core-needle biopsy (CNB) is currently the procedure of choice for work-up of suspicious breast lesion. It is mainly used for evaluation of suspicious breast lesions categorized as BI-RADS 4 and ...Ultrasound (US)-guided core-needle biopsy (CNB) is currently the procedure of choice for work-up of suspicious breast lesion. It is mainly used for evaluation of suspicious breast lesions categorized as BI-RADS 4 and 5 (Breast Imaging-Reporting and Data System). The conducted study included 56 female patients with detected suspicious breast leasions, and they underwent US-guided CNB during 1-year period with the aim to investigate the value of US-guided CNB of the breast in a tertiary-level large-volume oncological centre setting with respect of indications, technical adequacy and safety. 2 patients who entered the study were previously diagnosed as BIRADS 2, 3 patients as BIRADS 3, 18 patients as BIRADS 4 and 33 patients as BIRADS 5. In 14 patients with BC (breast cancer), both FNA (fine-needle aspiration) and CNB were performed, and the malignancy was accurately diagnosed by cytology in 9 patients, confirmed by subsequent CNB in all of them. ADH (atypical ductal hyperplasia) was initialy diagnosed by FNA in 5 patients, and in 2 of them, BC was initialy missed by FNA, but deteced by CNB. As it is known, the cytology has lower sensitivity for detection of BC than hystology, with false-negative rate ranging from 2.5% to 17.9%. In our material, 18.7% of carcinomas were initialy left undetected by FNAC, and subsequently confirmed by CNB. All confirmed carcinomas were correctly suspected on imaging, and categorized as BI-RADS 4 or 5, while all BI-RADS 2 and 3 findings were confirmed as benign on hystology. False-positive rate of imaging was 8%. An average number of 4 tissue cores (range: 2 - 7) was taken in our experience if good quality of the first 3 core was achieved, and there was no consistent reason to proceed with sampling.展开更多
文摘OBJECTIVE To evaluate core needle biopsy (CNB) as a mini-mally invasive method to examine breast lesions and discuss theclinical significance of subsequent immunohistochemistry (IHC)analysis.METHODS The clinical data and pathological results of 235 pa-tients with breast lesions, who received CNB before surgery, wereanalyzed and compared. Based on the results of CNB done beforesurgery, 87 out of 204 patients diagnosed as invasive carcinomawere subjected to immunodetection for p53, c-erbB-2, ER and PR.The morphological change of cancer tissues in response to chemo-therapy was also evaluated.RESULTS In total of 235 cases receiving CNB examination, 204were diagnosed as invasive carcinoma, reaching a 100% consistentrate with the surgical diagnosis. Sixty percent of the cases diag-nosed as non-invasive carcinoma by CNB was identified to havethe presence of invading elements in surgical specimens, and simi-larly, 50% of the cases diagnosed as atypical ductal hyperplasia byCNB was confirmed to be carcinoma by the subsequent result ofexcision biopsy. There was no significant difference between theCNB biopsy and regular surgical samples in positive rate of im-munohistochemistry analysis (p53, c-erbB-2, ER and PR; P >0.05).However, there was significant difference in the expression rate ofp53 and c-erbB-2 between the cases with and without morphologi-cal change in response to chemotherapy (P < 0.05). In most caseswith p53 and c-erbB-2 positive, there was no obvious morphologi-cal change after chemotherapy.CONCLUSION CNB is a cost-effective diagnostic method withminimal invasion for breast lesions, although it still has some limi-tations. Immunodetection on CNB tissue is expected to have greatsignificance in clinical applications.
文摘Objective: Axillary lymph node status is one of the most important prognostic indicator of survival for breast cancer, especially in ductal carcinoma in situ(DCIS). The purpose of this study was to investigate whether sentinel lymph node biopsy(SLNB) should be performed in patients with an initial diagnosis of DCIS. Methods: A retrospective study was performed of 124 patients with an initial diagnosis of DCIS between March 2000 and June 2014. The patients were treated with either SLNB or axillary node dissection during the surgery, and we compared the clinicopathologic characteristics, image features, and immunohistochemical results. Results: Eighty-two patients(66.1%) had pure DCIS and 25(20.2%) had DCIS with microinvasion(DCISM), 17(13.7%) updated to invasive breast cancer(IBC). 115 patients(92.7%) underwent SLNB, among them, 70 patients(56.5%) underwent axillary node dissection. 3 of 115 patients(2.6%) had a positive sentinel lymph node, only 1(1.4%) of 70 patients had axillary lymph node metastasis, in 84 patients(66.7%) who were diagnosed DCIS by core needle biopsy(CNB) and vacuum-assisted biopsy(VAB). 26 patients(31.0%) were upstaged into IBC or DCISM in the final histological diagnosis. The statistically significant factors predictive of underestimation were large tumor size, microcalcifications, comedo necrosis, positive Her-2 status, negative estrogen receptor status. Conclusion: The metastasis of sentinel lymph nodes in pure DCIS is very low, but the underestimation of invasive carcinoma in patients with an initial diagnosis of DCIS is an usual incident, especially in the cases when DCIS is diagnosed by CNB or VAB. Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with large tumor sizes, microcalcifications, comedo necrosis, positive Her-2 status, negative ER status are more likely to be DCISM and IBC in final diagnosis. SLNB should be performed in this part of patients.
文摘Aims: The reproducibility of Ki-67 between core-needle biopsies and surgical materials has not been well documented in the literature, although the concordance affects the utility of the Ki-67 labeling index based on the core-needle biopsy materials, which indicates the need for preoperative chemotherapy. The aim of this study was to reveal the reproducibility of Ki-67 between both materials and the cause of discrepancies. Methods and Results: We analyzed 137 cases of invasive carcinoma of the breast and the compared Ki-67-labeling index between core-needle biopsy and surgical materials. The Ki-67-labeling index of biopsy and surgical specimens ranged from 1% to 85% (median: 13%) and 1% to 80% (median: 12%), respectively. The discrepancy of Ki-67-labeling ranged from 0% to 55% (median: 4%) and could be calculated by the tumor size, hot spots of surgical materials, a high Ki-67-labeling index based on the core-needle biopsy materials, and the total length of core needles, respectively. Conclusions: The concordance rate of the Ki-67-labeling index between core-needle biopsies and surgical materials was favorable, so we can use each Ki-67-labeling index of core-needle biopsies as a marker for preoperative chemotherapy. Factors affecting the index discrepancy were hot spots, a high Ki-67-labeling index, and the total length of biopsy material. Judgements on the subtypes and clinical procedures of invasive breast carcinoma could be made comprehensively based on not only the Ki-67-labeling index but also the existence of hot spots and histological grade.
文摘Ultrasound (US)-guided core-needle biopsy (CNB) is currently the procedure of choice for work-up of suspicious breast lesion. It is mainly used for evaluation of suspicious breast lesions categorized as BI-RADS 4 and 5 (Breast Imaging-Reporting and Data System). The conducted study included 56 female patients with detected suspicious breast leasions, and they underwent US-guided CNB during 1-year period with the aim to investigate the value of US-guided CNB of the breast in a tertiary-level large-volume oncological centre setting with respect of indications, technical adequacy and safety. 2 patients who entered the study were previously diagnosed as BIRADS 2, 3 patients as BIRADS 3, 18 patients as BIRADS 4 and 33 patients as BIRADS 5. In 14 patients with BC (breast cancer), both FNA (fine-needle aspiration) and CNB were performed, and the malignancy was accurately diagnosed by cytology in 9 patients, confirmed by subsequent CNB in all of them. ADH (atypical ductal hyperplasia) was initialy diagnosed by FNA in 5 patients, and in 2 of them, BC was initialy missed by FNA, but deteced by CNB. As it is known, the cytology has lower sensitivity for detection of BC than hystology, with false-negative rate ranging from 2.5% to 17.9%. In our material, 18.7% of carcinomas were initialy left undetected by FNAC, and subsequently confirmed by CNB. All confirmed carcinomas were correctly suspected on imaging, and categorized as BI-RADS 4 or 5, while all BI-RADS 2 and 3 findings were confirmed as benign on hystology. False-positive rate of imaging was 8%. An average number of 4 tissue cores (range: 2 - 7) was taken in our experience if good quality of the first 3 core was achieved, and there was no consistent reason to proceed with sampling.
