Assessment accuracy of core needle biopsy for hormone receptors in breast cancer: a meta-analysis

The concordance of hormone receptors (HR) status identified by core needle biopsy (CNB) compared with excisional biopsy (EB) has been widely reported, but results were extremely variable and underpowered. To derive a more precise estimation of assessment accuracy of CNB for HR in breast cancer, we conducted a meta-analysis of all eligible studies comparing concordance or disconcordance between CNB and EB for HR status. Eligible articles were identified by search of databases including PubMed, Web of Science, EMBASE, and Chinese Biomedical Literature database for the period up to November 2011, and the reference lists of identified studies, relevant reviews, meta-analyses, and abstracts from recent conference proceedings were reviewed as a augmented searching. Finally, a total of 21 articles involving 2,450 patients for estrogen receptor (ER) and 2,448 patients for progesterone receptor (PR) were included and analyzed in this analysis. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies checklist. The overall aggrement between CNB and EB were 92.8?% for ER (κ?=?0.78) and 85.2?% for PR (κ?=?0.66), indicating a good agreement in PR and a better result in ER. The pooled sensitivity and specificity were 97.3?% (95?% CI 96.0-98.2) and 82.0?% (95?% CI 68.2-90.6) for ER, and the corresponding values for PR were 92.3?% (95?% CI 88.2-95.1) and 76.5?% (95?% CI 64.6-85.3), respectively. The pooled positive likelihood ratios was 5.39?% (95?% CI 2.92-9.97) and the negative likelihood ratios was 0.03?% (95?% CI 0.02-0.05) for ER, the corresponding values for PR were 3.93?% (95?% CI 2.53-6.11) and 0.10?% (95?% CI 0.07-0.16), respectively. In summary, although a good agreement was observed between CNB and EB for both ER and PR, we still suggest that negative HR testing results should be interpreted with caution or repeated on EB.     

Ultrasound-guided core needle biopsy for breast cancer: preliminary report

BACKGROUND: Ultrasound-guided automated percutaneous core needle biopsy (US-CNB) for breast tumors has been introduced into clinical practice, but it has not yet been used routinely. We evaluated its usefulness, especially in terms of histological accuracy. METHODS: Thirty-one consecutive patients underwent mammography followed by breast biopsy with the automated core needle biopsy device. RESULTS: Mammography was highly suggestive of malignancy or suspicious abnormalities in 17 cases whose histological findings from US-CNB specimens were invasive ductal carcinoma without exception. The other 14 cases with benign or probably benign mammography findings showed no malignancy histologically in the US-CNB specimens. In cases of malignancy, the accuracy rates of histological findings for the specimens obtained by US-CNB were 94.1% in histological type, 100% in direct infiltration, 82.4% in lymphatic infiltration, 82.4% in venous infiltration, 94.1% in histological grading and 82.4% in intraductal spread. CONCLUSION: US-CNB was useful for making reliable preoperative histopathological diagnosis and may substitute fine needle aspiration biopsy and surgical biopsy.     

Reliability of receptor assessment on core needle biopsy in breast cancer patients

We compared the breast core needle biopsy and the resection specimen with respect to estrogen (ER), progesterone (PR) and human epidermal growth factor receptor 2 (HER2) status to identify predictors for discordant findings. We retrospectively collected data from 526 newly diagnosed breast cancer patients. ER, PR and HER2 status had been assessed in both the core needle biopsy and resection specimen. The assessment of ER by immunohistochemistry (IHC) in core needle biopsy was false negative in 26.5% and false positive in 6.8% of patients. For the PR status the false negative and false positive results of core needle biopsy were 29.6% and 10.3%, respectively. The results of the HER2 status, as determined by IHC and silver in situ hybridization (SISH), were false negative in 5.4% and false positive in 50.0%. We need to be aware of the problem of false negative and false positive test results in ER, PR and HER2 assessment in core needle biopsy and the potential impact on adjuvant systemic treatment. With current techniques, we recommend using the resection specimen to measure these receptors in patients without neoadjuvant treatment. A better alternative might be the use of tissue microarray, combining both core needle biopsy and resection specimen.     

Roles of fine-needle aspiration and core needle biopsy in the diagnosis of breast cancer

Background  

There is controversy regarding which of the two biopsy methods, fine-needle aspiration (FNA) or core needle biopsy (CNB), should be routinely employed for diagnosis of breast cancer. The aim of this study was to evaluate the efficacy of FNA compared to CNB and to explore the value of performing both FNA and CNB.     

Reliability of core needle biopsy for determining ER and HER2 status in breast cancer

BackgroundSeveral studies have assessed the concordance of estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status between core needle biopsy (CNB) and resection specimens, usually in small patient series and with discordant results.Patients and methodsER and HER2 status determined on CNB and tissue micro-arrays of resected tumors were compared for patients treated at the Leiden University Medical Center (LUMC). When results were discordant, whole-sized slides were analyzed. Additionally, literature was searched for published patient series and combined with our data to assess the concordance of ER and HER2 determination between CNB and resection specimens.ResultsIn the LUMC series, concordance for ER status was 99.1%. Combined concordance from 20 studies and the LUMC patient series was 93.7%. For HER2 testing, concordance was 96.2% for patients in the LUMC series. Our study and three others have investigated the concordance when HER2 was determined according to the American Society of Clinical Oncology and College of Pathology guidelines and overall concordance was 97.8%.ConclusionsConcordance between CNB and surgical specimens was high for both ER and HER2 testing. However, we recommend retesting ER-negative CNB results on the surgical specimen and performing in situ hybridization assays on HER2 immunohistochemistry 3+ CNBs to confirm HER2 status.     

X线摄片计算机辅助定位穿刺活检对早期乳腺癌的诊断价值

为了探讨乳腺钼靶X线摄片在计算机辅助下立体定位核心穿刺活检对临床上不能扪及肿块的早期乳腺癌的诊断价值,对48例临床上不能扪及明确肿块、乳腺X线摄片发现可疑病变患者,采用计算机辅助立体定位核心穿刺,取得活组织行病理检查。结果示,48例患者中共发现早期乳腺癌7例,占14.6%。初步研究结果提示,X线摄片计算机辅助立体定位核心穿刺活检技术具有定位精确、可靠程度高、创伤小、操作简单等优点,对早期乳腺癌的诊断有重要价值。     

粗针穿刺活检在乳腺肿块诊断中的应用

目的:探讨粗针穿刺活检(CNB)在乳腺肿块诊断中的应用价值.方法:对触诊为乳腺肿块的患者行粗针穿刺活检和开放活检,对病理结果比较分析.结果:送检85例穿刺标本病理结果分别为:乳腺增生症53例,乳腺癌26例,慢性炎症3例,乳腺纤维腺瘤3例.穿刺与切除术后病理符合率98.1%,漏诊1例占1.9%. 结论:CNB是一种操作简单、损伤小、准确可靠的诊断方法, 在乳腺肿块的确诊中有很大应用价值.     

Evaluation and indications of ultrasound-guided vacuum-assisted core needle breast biopsy

BACKGROUND: The Mammotome is a diagnostic tool used under stereotactic or with ultrasound guidance. A clear indication for Mammotome use under stereotactic guidance is when a non-palpable microcalcification is a target. However, the indications for the use of the Mammotome under ultrasound guidance vary among institutions, and it is difficult to find a place for the Mammotome among conventional biopsy techniques. The Mammotome biopsy has been available in our hospital since July 1999. We assessed the effectiveness and indications of ultrasound-guided Mammotome biopsy. METHODS: We performed Mammotome biopsies in 433 cases requiring histological diagnosis from July 1999 to September 2006, using an 11-gauge articulated arm-type Mammotome under ultrasound guidance. There were 377 mass lesions including 83 non-palpable cases and 56 hypoechoic lesions. RESULTS: The indications for Mammotome biopsy were 162 cases with inconsistent fine needle aspiration (FNA) and imaging findings, 114 cases indeterminate by FNA, 68 cases of an identified pathological type before neoadjuvant chemotherapy and confirmation of hormone receptor status, 36 inadequate cases by FNA, 20 cases of confirmation of fibroadenoma and other benign tumors, 8 removal cases of fibroadenoma, 8 microcalcification cases, and 17 others. The target lesion was obtained in 99.5% of the cases. CONCLUSIONS: Ultrasound-guided Mammotome biopsy is an accurate and useful diagnostic method that enables sufficient amounts of tissue to be obtained with minimal invasion and few complications. The Mammotome is the first choice for obtaining a definitive pathological diagnosis in breast lesions.     

Tumor microvessel density and prognosis in node-negative breast cancer

Microvessel density (MVD) of breast cancer is widely regarded as a prognostic factor, but results from studies on the most important case series have produced conflicting results. The present study was performed with confirmatory intent to define the prognostic relevance of MVD on a series of 378 node-negative-breast-cancer patients, much larger than any other series previously analyzed. Microvessels were stained using Factor-VIII antibody and an immunoperoxidase reaction. MVD was determined independently by 2 observers according to Weidner's methods. In parallel, cell proliferation was evaluated as S-phase fraction and determined according to the 3H-thymidine-labeling index method (TLI). Estrogen and progesterone receptors were quantitatively assessed using the dextran-charcoal technique. Tumor MVD varied greatly from tumor to tumor (2 to 232 MV/mm2) and was unrelated to patient age and menopausal status, or to tumor size, histology and steroid-receptor status. A significant (p = 0.004) but weak inverse correlation (rs = -0.188) was observed with cell proliferation. Univariate analysis using 40 MV/mm2 as cut-off showed an inverse relation with 5-year relapse-free survival (82% vs. 71%, p = 0.018). This finding was limited to very small tumors, slowly proliferating tumors and ER-negative tumors. Multivariate analysis identified tumor size and TLI, but not MVD, menopausal status or ER as independent prognostic factors.     

Pathological aspects of core needle biopsy for non-palpable breast lesions

Recently, the incidence of non-palpable or noninvasive breast cancer has increased. Consequently, criteria for choosing procedures to obtain pathological materials had changed. Fine needle aspiration biopsy cytology (FNA) and core needle biopsy (CNB) are both reliable procedures for detecting breast cancer. However, for non-palpable lesions, the diagnostic accuracy of CNB is higher. The main limits of FNA are the high rate of insufficient sampling and inability to determine invasiveness. CNB is an established alternative to surgical biopsy, and CNB can avoid excess surgical biopsies in a large number of patients. In addition to accurate histological diagnosis, there is interest in obtaining prognostic information from CNB, especially for patients being considered for preoperative (neoadjuvant) therapy. CNB provides useful information about histologic type and grade. However, an unavoidable problem of CNB is underestimation of invasion. On the other hand, there is good concordance in particular for estrogen receptor (ER) and progesterone receptor (PR) between CNB and surgical excision. Several aspects of CNB remains controversial, such as diagnosing papillary lesions by CNB, problems regarding tumor cell displacement after CNB, and management of lobular neoplasia (LN) on CNB.     

乳腺X线立体定位空芯针活检的临床应用

目的评价乳腺X线立体定位空芯针活检在乳腺疾病诊治中的价值.方法采用计算机辅助乳腺X线立体定位系统、弹射式自动活检枪和14-gauge的空芯针.结果对影像学诊断发现异常的71个病灶进行X线立体定位空芯针活检.对照手术或1年以上(13～45个月)的随访结果,该组的诊断特异性和敏感性分别为100％和92％.有73％的良性病灶经空芯针活检明确诊断后免除了手术活检.结论 X线立体定位空心针活检是用于乳腺X线发现的临床摸不到肿块的病灶的一种安全有效的微创活检方法,并使大量良性病变免除手术活检并节省了医疗开支.     

乳腺癌核芯针穿刺印片与组织学诊断的比较研究

目的 探讨印片细胞学(TIC)与组织病理诊断以及印片免疫细胞化学与免疫组织化学检测结果的一致性,评价在乳腺癌新辅助化疗前TIC诊断的临床应用价值.方法 收集行核芯针穿刺组织TIC诊断的乳腺肿物患者289例,其中287例有核芯针活检(CNB)病理结果对照,190例有术后病理结果对照.289例中,64例行印片的雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER-2)免疫细胞化学检测,其中52例有CNB免疫组织化学检测结果,43例有术后病理免疫组织化学检测结果.结果 TIC诊断良性22例,恶性263例,不满意标本4例.假阴性率和不满意率均为1.4%,假阳性率为0.35%.与术后病理结果比较,TIC和CNB诊断乳腺癌的敏感性分别为96.2%和95.0%(P=0.601),特异性分别为87.5%和100%(P=0.471),准确率分别为95.8%和95.3%(P=0.804),差异均无统计学意义.ER、PR和HER-2印片免疫细胞化学检测结果与CNB的免疫组织化学检测结果的符合率分别为86.5%、75.0%和78.8%,与术后病理免疫组织化学检测结果的符合率分别为88.4%、74.4%和75.6%,CNB与术后病理免疫组织化学检测结果的符合率分别为83.7%、74.4%和76.5%,三者差异无统计学意义(P＞0.05).结论 TIC诊断乳腺癌的敏感性、特异性和准确率较高,与CNB组织病理诊断无明显差异,可以辅助CNB为乳腺肿物患者提供快速的细胞学诊断.印片免疫细胞化学方法可以辅助CNB作为新辅助化疗前检测乳腺癌患者受体水平的手段之一.     

The use of positive core wash cytology to estimate potential risk of needle tract seeding of breast cancer: directional vacuum-assisted biopsy versus automated core needle biopsy

Background  

A disadvantage of the image-guided core needle biopsy is that needle tract seeding may occur and affect the local recurrence and overall survival rates of patients after breast-conserving surgery, although the chance is small. The purpose of this study was to compare the potential risk of needle tract seeding of breast cancer from ultrasonographically guided needle biopsies that were performed with a directional vacuum-assisted device and an automated core needle gun.     

Factors predictive of breast cancer in open biopsy in cases with atypical ductal hyperplasia diagnosed by ultrasound-guided core needle biopsy

Aims

The purpose of the study was to explore factors predictive of breast cancer as diagnosed by excision biopsy in cases with a diagnosis of atypical ductal hyperplasia (ADH) on ultrasound-guided core needle biopsy (CNB).

Patients and methods

We carried out diagnosis of breast lesions by ultrasound-guided CNB in a single hospital in Taiwan from November 2003 to October 2009. Patients who were diagnosed with ADH and subsequently underwent excision biopsy were included in this study (n = 124).

Results

Fifty-six of the 124 patients who were included (45.2%) had cancer, and the remaining 68 had benign lesions. By multivariate analysis of all clinical characteristics and on the basis of the imaging features in these cases, older patient age (≥50 y/o, OR: 3.910, p = 0.005), larger tumour size (≥15 mm, OR: 3.398, p = 0.013), and the presence of architectural distortion by mammography (OR: 10.7, p = 0.036) were found likely to be associated with breast cancer.

Conclusions

Open biopsy is necessary in patients who were diagnosed with ADH on CNB. Older patients (≥50 y/o), with a larger tumour size (≥15 mm) and an abnormal mammography are especially likely to have breast cancer.     

Reliability of prognostic factors in breast carcinoma determined by core needle biopsy

OBJECTIVE: The aim of this study was to evaluate the reliability of information obtained by core needle biopsy (CNB). METHODS: We studied 111 women (112 lesions) with breast cancer who underwent CNB and subsequent surgical excision. Six factors (histological type, nuclear grade, histological grade, estrogen receptor (ER) status, progesterone receptor (PR) status, and human epidermal growth factor receptor-2 (HER2) status) were evaluated in a blinded fashion at CNB and at surgical excision. RESULTS: The histological type at CNB correlated exactly with that of the excisional specimen in 83% (87/105) of the cases. Of the 45 in situ lesions at CNB, 16 (36%) were found to have invasive carcinoma at surgical excision. The difference between the specimens from CNB and those from surgery in terms of the absolute concordance rate and kappa statistic value were 61% with a fair kappa value (0.26) in the nuclear grade, 75% with a moderate kappa value (0.55) in the histological grade, 95% with an almost perfect kappa value (0.84) in ER, 88% with a substantial kappa value (0.70) in PR and 88% with a substantial kappa value (0.65) in HER2. Regarding the evaluation of nuclear and histological grades, a trend toward greater accuracy was observed when thicker specimens were used. CONCLUSIONS: CNB provided reliable information on the histological type of invasive carcinoma. It also evaluated ER, PR and HER2 (only in cases where the score was 3+) accurately in spite of the limited quantity of the specimen obtained with the thin (16-gauge) needle.     

同侧多原发灶乳腺癌病灶间异质性的研究

背景与目的：同侧多原发灶乳腺癌临床并不鲜见,既往对于病灶间异质性的研究多数基于术后标本。本研究比较了术前空芯针穿刺确诊的同侧多原发灶乳腺癌病灶间的异质性,探讨其对临床决策的影响。方法：回顾性分析北京大学肿瘤医院暨北京市肿瘤防治研究所乳腺中心2013－2016年间空芯针穿刺确诊的同侧多原发灶乳腺癌资料,比较不同病灶组织学及雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)和Ki-67等免疫组织化学结果的异质性,并根据免疫组织化学结果判定病灶分子分型。结果：共75例同侧多原发灶乳腺癌纳入本研究。已完成腋窝评价的69例患者中腋窝淋巴结阳性51例(68.0%)。9例(12.0%)病灶间组织学类型和组织学分级存在异质性。ER、PR、HER-2和Ki-67结果病灶间存在异质性的患者分别为1例(1.3%)、10例(13.3%)、1例(1.3%)和9例(12.0%)。10例(13.3%)病灶之间分子分型存在异质性。按照现行指南进行免疫组织化学检查,4例(5.3%)治疗决策可能会受到影响。结论：空芯针穿刺确诊同侧多原发灶乳腺癌病灶间组织学结果及免疫组织化学结果存在异质性,仅对主要病灶进行免疫组织化学检测可能影响部分患者的治疗决策。     

Impact of sentinel lymph node biopsy by ultrasound-guided core needle biopsy for patients with suspicious node positive breast cancer

Purpose

The purpose of this study was to investigate the accuracy of preoperative diagnostic tools for axillary lymph nodes (LNs) staging of breast cancer.

Materials and Methods

A total of 2464 consecutive patients with operable breast cancer were prospectively identified at our institution between April 2012 and March 2017. Patients with suspicious axillary LN of breast cancer were assessed using preoperative ultrasound(US) or computed tomography (CT), underwent fine-needle aspiration cytology (FNA) or core needle biopsy (CNB). The inclusion criteria for both FNA and CNB were a cortical thickness >3 mm or abnormal morphological characteristics. Patients with biopsy-proven metastasis underwent axillary lymph node dissection (ALND), and those with a negative FNA or CNB underwent sentinel lymph node biopsy (SNB). If the SNB was positive, ALND was performed. Diagnostic accuracy for SNB was calculated for both FNA and CNB. In addition, the patients in this study were divided into two groups as follows: the cN0-FNA group (suspicious LN but negative FNA) and cN0-CNB group (suspicious LN but negative CNB).

Results

A number of patients with negative US/CT findings of LNs were 1406, with 744 undergoing FNA and 272 undergoing CNB for suspicious LNs. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 65, 99, 99, 80, and 85% in FNA, and 87, 100, 100, 93 and 95% in CNB, respectively. SNB was performed in 172 (cN0-CNB group) of 272 CNB and 487 (cN0-FNA group) of 744 FNA patients. One hundred and seventy-two patients from the cN0-CNB group (Tis 6, T1 97, T2 66, T3 3 patients) treated with SNB were compared to 487 from the cN0-FNA group (Tis 21, T1 225, T2 233, T3 8 patients) in terms of number of LN metastasis. A number of patients with more than 3 positive SNB and positive LNs were 9 (5%) and 0 (0%) in cN0-CNB group, and 78 (16%) and 24 (5%) in cN0-FNA group, respectively. A number of patients who had complications such as haematoma and pain at the time of 7 to 14 days after CNB and FNA were 1 (0.5%) and 1 (0.5%) in cN0-CNB group, and were 0% and 0.2% in cN0-FNA group (p = 0.44), respectively.

Conclusions

The preoperative diagnosis of axillary LNs was influenced by the diagnostic tool used. CNB is a reliable method for the preoperative diagnosis of LN metastasis.

     

乳腺癌细针穿刺活检的临床应用价值

背景与目的：随着乳腺癌术前诊疗手段的发展,细针穿刺似乎不再受临床医生的青睐。细针穿刺作为乳腺癌的术前诊断方法之一,其安全及有效性存在争议。本研究探讨30年来我院乳腺癌细针穿刺与复发、转移的关系。方法：统计我院1975—2006年1 260例乳腺癌患者的临床资料,根据是否术前细针穿刺分组,比较2组间临床基本特点、复发转移率、无瘤生存率。结果：细针穿刺阳性率为61.4%,其中Ⅳ期患者阳性率最高,达100%;细针穿刺组中以Ⅱ期和Ⅲ期患者居多,均为45.2%;细针穿刺组和非细针穿刺组的局部复发率(7.0% vs 6.4%)、复发转移率(13.2% vs 14.0%)、5年无瘤生存率(82.0% vs 81.0%)及10年无瘤生存率(51.0%vs 64.0%)差异均无统计学意义。结论：细针穿刺具有易操作、阳性率高、对复发及生存无影响等优点,因此对乳腺癌患者的术前诊断仍有较高的临床应用价值。     

Automatic needle biopsy in the diagnosis of early breast cancer

An automatic needle biopsy system, Bioptycut, has been evaluated for use in the outpatient biopsy of 107 patients with suspected operable breast cancer. Of the 107 patients, 96 proved to have malignancy. The sensitivity of the test was 65%, and the specificity 100%. Using a fine gauge needle the sensitivity was originally less than that of Trucut biopsy, but improved results were obtained with more experience.