Core needle biopsy versus fine needle aspiration biopsy in breast--a historical perspective and opportunities in the modern era

Breast fine-needle aspiration biopsy (FNAB) by palpation is on the decline, due to its limitations in diagnostic accuracy, decreased sensitivity, and its replacement with core needle biopsy (CNB). Despite its decreasing utility, superficial fine-needle aspiration (FNA) in breast is still the main modality for evaluating metastatic lesions, recurrence, and axillary lymph node metastasis. New modalities including proteomic pattern expression and methylation profiling of breast lesions are other promising techniques that can be used as ancillary tests for refining the diagnosis of breast lesions using FNAB. Image-guided breast FNA proves to be a successful alternative with high sensitivity and specificity. In this review, the advantages, disadvantages, and inherent limitations of breast FNA and CNB, and new advanced techniques are discussed.     

An interinstitutional review of the value of FNAB in pediatric oncology in resource-limited countries

Fine‐needle aspiration biopsy (FNAB) has been widely accepted as a reliable diagnostic modality in the general pediatric population, but its role in pediatric oncology still remains elusive. With new treatment protocols subscribing to preoperative chemotherapy, the need for a quick, minimally invasive, and accurate diagnostic procedure has arisen. This study assesses the feasibility of FNAB in childhood malignancies to render a specific diagnosis on which treatment can be initiated. An 11‐year retrospective study was done on FNABs in patients 19 years and under referred for clinically malignant mass lesions. Cases were confirmed with histology, immunocytochemistry, flow cytometry, or clinical follow‐up. Of the 357 patients referred for FNABs, 36 patients were lost to follow‐up and 31 FNABS were inadequate. A total of 290 cases were included in the study, of which 68 (23%) cases were benign and 222 (77%) were malignant. The most frequently occurring tumors were nephroblastoma (68), non‐Hodgkin's lymphoma (39), rhabdomyosarcoma (22), Hodgkin's lymphoma (22), and neuroblastoma (22). The sensitivity of the procedure for neoplasia was 96.6%, the specificity 97.0%, positive predictive value 99.0%, and negative predictive value 90.1%, with a diagnostic accuracy of 96.7%. The ability of FNAB to enable a specific diagnosis to be made, that is correct and accurate subtyping of the tumor on which chemotherapy or radiotherapy could be commenced was 75.7%. This study shows that FNAB can be used with confidence to confirm malignancy in children. With clinicoradiological correlation and the aid of ancillary techniques, FNAB allows a rapid and accurate preoperative diagnosis for definitive therapy commencement in most cases. Diagn. Cytopathol. 2012. © 2011 Wiley Periodicals, Inc.     

Should fine‐needle aspiration cytology be the first choice diagnostic modality for assessment of all nonpalpable breast lesions? The experience of a breast cancer screening center in Alexandria,Egypt

Fine‐needle aspiration cytology (FNAC) of breast masses has been replaced by ultrasound‐guided core‐needle biopsy (USG‐CNB) in many countries. However, in Egypt, breast FNAC continues to play the major role in diagnosing breast masses. In this prospective study, we evaluated the efficacy of USG‐FNACs performed at a breast cancer screening center by comparing the FNAC results with the corresponding definitive histological examination outcome. We also investigated the role that CNB can play as a complementary diagnostic tool for FNAC in selected cases. A total of 229 consecutive nonpalpable breast masses were included in this study. Each FNAC was placed into one of four categories: 3.5% nondiagnostic, 13.5% benign, 12.3% atypical/suspicious (indeterminate), and 70.7% malignant. The overall diagnostic accuracy was 98.9%, with a specificity and sensitivity of 99.3 and 96.7%, respectively. The overall positive predictive values and negative predictive values were 99.3 and 96.7%, respectively. Only 37 masses (16%) were converted to CNB, with the indeterminate cytology being the most common cause (54%) for this conversion. Two cases demonstrating the superior benefit of FNAC over CNB are illustrated. Although we started the study by reserving CNB as a first choice to assess microcalcifications without architectural distortion, we ended the study by deciding to perform combined FNAC and CNB for this type of lesions. In conclusion, aiming to maximize the preoperative diagnosis of cancer, it would be cost efficient and time saving to use FNAC as a first‐line investigation to benefit from the wealth of cytological information yielded, followed by CNB in selected cases. Diagn. Cytopathol. 2010;38:880–889. © 2010 Wiley‐Liss, Inc.     

Metachronous soft-tissue masses in children and young adults with cancer: correlation of histology and aspiration cytology

We describe a series of 28 fine needle aspiration biopsies (FNAB) of soft tissue from 22 patients. Four patients had two separate FNABs, and one had three aspiration procedures. The patient population was limited to children and young adults (age range, 2 months to 29 years; mean, 16 years) who were known to have diverse forms of cancer, and who subsequently developed a mass in the peripheral soft tissues (including breast). The interval between the time of diagnosis of the primary malignant neoplasm and FNAB ranged from 1 day to 17 years (mean, 39 months). All FNAB diagnoses were confirmed by subsequent surgical open biopsy or clinical follow-up greater than 1 year. No complications occurred from the procedure. The cytomorphology is presented in selected cases and correlated with the patient's original tissue histopathology. Twenty aspirates were diagnosed as cytologically malignant, one as suspicious for malignancy. Seven were considered benign. None were unsatisfactory. One false-positive and no false-negative cytologic diagnoses were obtained. The overall accuracy of FNAB diagnoses was 96%, while sensitivity was 100% and specificity 88%. Sites of aspiration included soft tissues of the head and neck (seven cases), trunk (eight cases), breast (four cases), and extremities (nine cases). Malignant cytologic diagnoses included sarcoma (thirteen), seminoma (two), lymphoma/leukemia (two), melanoma (one), undifferentiated neoplasm (one), and neuroblastoma (one). Electron microscopy of aspirated cells was used to confirm the diagnosis in two cases. Fine needle aspiration biopsy of soft tissue masses from children and young adults with cancer demonstrates a high diagnostic accuracy, and its use is justified in this population.     

Is core needle biopsy superior to fine‐needle aspiration biopsy in the diagnosis of papillary breast lesions?

Since the 1980s core needle biopsy (CNB) has gained remarkable popularity and in many institutions it has replaced fine-needle aspiration biopsy (FNAB). However, similar to FNAB, limitation remains in the ability of this procedure to reliably diagnose a small, but prognostically significant, number of breast lesions. These include entities such as atypical ductal hyperplasia, fibro-epithelial tumors, radial scar, papillary lesions, and lobular neoplasia. To assess the diagnostic accuracy of CNB vs. FNAB in the same breast lesions, we reviewed our cases of papillary lesions of the breast. In a retrospective study, we identified 36 cases of FNAB and 11 cases of CNB diagnosed as papillary lesions and compared the results with their corresponding surgical specimen. Interpretation ranged from papillary vs. atypical papillary lesions favoring benign vs. malignant tumors, respectively. Occasionally, definitive diagnosis of papillary carcinoma was entertained. Immunohistochemical staining with smooth muscle actin was used to evaluate the presence or absence of a myoepithelial cell layer. FNAB had benign findings in 21 lesions, atypical in 10, and malignant in five. Of the five lesions yielding malignant features, four had invasive carcinoma and one had micropapillary ductal carcinoma in situ (DCIS). Surgery revealed invasive carcinoma in three of the cases interpreted as atypical papillary lesions and invasive cancer and micropapillary DCIS in three of the cases diagnosed as benign lesions. Similar results were obtained with CNB. DCIS was found in one out of six of the cases diagnosed as papilloma. Out of the four cases that were interpreted as atypical papillary lesion, surgery revealed invasive carcinoma in one case and one case had micropapillary DCIS. Diagnosis of malignancy was confirmed by histology in one case interpreted as papillary carcinoma by CNB. This study suggested that both FNAB and CNB share similar diagnostic challenges and a follow-up surgical excision is indicated when diagnosis of a papillary lesion is entertained by both procedures.     

Utility of glypican‐3 and survivin in differentiating hepatocellular carcinoma from benign and preneoplastic hepatic lesions and metastatic carcinomas in liver fine‐needle aspiration biopsies

Glypican‐3 (GPC‐3), a membrane‐anchored heparin sulfate proteoglycan, has been shown to be expressed in ～80% of hepatocellular carcinoma (HCC) but not in benign hepatic lesions. Survivin, a novel inhibitor of apoptosis, and a prognostic marker, has also been expressed in HCC. We evaluated these two immunomarkers (GPC‐3 and survivin) in differentiating HCC from benign and preneoplastic hepatic lesions and metastatic carcinomas, comparing them to HepPar‐1 (hepatocyte paraffin‐1) in liver fine‐needle aspiration biopsies (FNAB). Immunohistochemistry for GPC‐3, survivin and HepPar‐1 was performed on 92 FNAB including HCC, hepatic cirrhosis, focal nodular hyperplasia (FNH), hepatic adenoma, dysplastic hepatic nodules and metastatic carcinomas. Immunostaining was scored as positive, if ≥10% of tumor cells stained. GPC‐3 is immunoexpressed in 56.8% of HCC, but not in benign and preneoplastic hepatic lesions, or metastatic carcinomas; whereas survivin is expressed in HCC (86.4%), benign hepatic lesions (85.7%), dysplastic hepatic nodules (100%) and metastatic carcinomas (94.3%). HepPar‐1 is immunoexpressed in HCC (72.7%), benign hepatic lesions (100%), dysplastic nodules (100%) and metastatic carcinomas (2.9%). The sensitivity and specificity of GPC‐3, survivin and HepPar‐1 for detection of HCC are 56.8 and 100%, 86.4 and 6.3%, 72.7 and 70.8%, respectively. GPC‐3 is a reliable and more specific immunohistochemical marker than survivin for the diagnosis of HCC in FNAB. HepPar‐1, although a more sensitive marker than GPC‐3, has a lower specificity for detection of HCC. Our data supports the potentially significant diagnostic utility of GPC‐3 in FNABs in differentiating primary malignant from benign and preneoplastic liver lesions, and metastatic carcinomas. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Value of cytopathologist‐performed ultrasound‐guided fine‐needle aspiration as a screening test for ultrasound‐guided core‐needle biopsy in nonpalpable breast masses

Fine‐needle aspiration (FNA) of breast masses in the United States has been on the decline for the last decade and has been largely replaced by ultrasound‐guided core‐needle biopsy (UG‐CNB). Some studies show core‐needle biopsy (CNB) is superior to FNA in terms of absolute sensitivity, specificity, and inadequate rate. However, the importance of a skilled aspirator, experienced cytopathologist, and immediate cytological evaluation (ICE) in FNA is often not considered. CNB is more expensive, invasive, risky, and painful than FNA. This prospective study examines the value of cytopathologist‐performed ultrasound‐guided FNA (UG‐FNA) with ICE as a screening test for cytopathologist‐performed UG‐CNB on nonpalpable or difficult‐to‐palpate solid breast masses visible on ultrasound. One hundred twenty consecutive nonpalpable or difficult‐to‐palpate presumably solid breast masses in 109 female patients from January2, 2008 to June 30, 2008 underwent cytopathologist‐performed UG‐FNA with ICE. Twenty cases were converted to cytopathologist‐performed UG‐CNB because ICE was inadequate, hypocellular, atypical, suspicious, or malignant. Patients with clearly benign cytology did not undergo UG‐CNB. UG‐FNA with ICE reduced the percentage of patients undergoing UG‐CNB by 87%. A new role for cytopathologist‐performed UG‐FNA of nonpalpable breast masses has been identified. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

A comparative study of 200 head and neck FNAs performed by a cytopathologist with versus without ultrasound guidance: evidence for improved diagnostic value with ultrasound guidance

Our previous study showed that the sensitivity of head and neck fine-needle aspiration (FNA) procedures was significantly better in the cytopathologist-performed group than in the noncytopathologist-performed group (96 versus 67%). Recently, cytopathologists have learned to use ultrasound machines to assist them in performing FNA procedures. This study was designed to assess whether cytopathologist-performed FNAs with ultrasound guidance can improve diagnostic value in comparison to those done without ultrasound guidance. Two hundred consecutive head and neck FNA cases performed by the same cytopathologist with and without ultrasound guidance were reviewed. Cases consisted of 100 ultrasound-guided FNAs (USGFNAs) performed between July 2008 and March 2009 and 100 palpation-guided FNAs (PGFNAs) performed before July 2008. These cases were correlated with follow-up surgical diagnosis. The diagnostic, suspicious/atypical/suggestive, and nondiagnostic rates (%) for the head and neck FNAs were 83 versus 86, 10 versus 13, and 7 versus 1 in PGFNA group versus USGFNA group, respectively. Surgical follow-up specimens were found in 50 PGFNAs versus 35 USGFNAs. The true-positive, true-negative, false-positive, and false-negative rates (%) were 92, 2, 2, and 4 versus 80, 17, 3, and 0 in PGFNAs versus USGFNAs, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 96, 50, 98, 33, and 94% in PGFNAs versus 100, 86, 97, 100, and 97% in the USGFNA group, respectively. This study also shows increased FNAs of thyroid and salivary glands and other smaller nonpalpable lesions with ultrasound guidance. USGFNAs performed by a cytopathologist could significantly improve the specificity and NPV (P = 0.04) while preserving virtually the same excellent sensitivity and PPV as those of PGFNAs. With ultrasound guidance, a cytopathologist will be able to perform FNAs in smaller, nonpalpable lesions and target complex lesions with confidence and accuracy, thus achieving a better outcome.     

Utility of fine-needle aspiration biopsy in solid renal masses

Renal fine-needle aspiration biopsy (FNAB) is used in several clinical scenarios: in patients with classic radiographic lesions; in non-operable patients with presumed high stage disease; and in patients with radiographic problematic lesions. Although overall, FNAB is a sensitive test, its role in the latter two populations has not been clearly established. To investigate the utility of FNAB in these patients, we retrospectively evaluated 43 renal FNABs in regards to diagnostic accuracy and clinical outcome. FNAB diagnoses were: malignant (36), suspicious (6), and insufficient (1). Our results indicate: 1) renal FNAB is accurate in patients with high stage lesions; 2) FNAB is less accurate in patients with radiographic problematic lesions; 3) the FNAB diagnosis of malignant increases the post-FNAB probability of malignancy, whereas the diagnosis of suspicious decreases the probability; and 4) there is excellent correlation for nuclear grade. We conclude that renal FNAB is useful in evaluating renal masses. Diagn Cytopathol 1996;14:14–19. © 1996 Wiley-Liss, Inc.     

Ductopapillary apocrine carcinoma of the eyelid metastatic to the parotid gland: Report of a case diagnosed by fine‐needle aspiration biopsy

Ductopapillary apocrine carcinoma (DPAC) of the eyelid is a rare malignant neoplasm in the periocular region. The relative rarity of this tumor is a diagnostic challenge to the cytopathologist, especially when present as a metastatic lesion to an intraparotid lymph node, where the differential diagnosis includes primary parotid neoplasms, as well as various other metastatic malignancies. There are only a few reported cases of recurrent and metastatic DPAC of the eyelid, and to our knowledge, metastatic DPAC diagnosed by fine‐needle aspiration biopsy (FNAB) has not been described. We report a case of a 65‐year‐old African‐American male with a history of ductopapillary apocrine adenocarcinoma of the eyelid, diagnosed 6 weeks ago now presenting with a recurrence in the same area. Magnetic resonance imaging of the head and neck revealed an intraparotid mass also. FNAB of the parotid mass showed a well‐differentiated papillary adenocarcinoma with a cystic component, similar to a previously excised ductopapillary apocrine adenocarcinoma of the eyelid. Diagn. Cytopathol. 2009. © 2008 Wiley‐Liss, Inc.     

The value of fine needle aspiration biopsy in the diagnosis and prognostic assessment of palpable breast lesions

In recent years there appears to be a growing movement toward the use of core needle biopsy (CNB) over fine needle aspiration biopsy (FNAB) for the detection of breast carcinoma. This tendency is caused in part by the idea that CNB can provide a more specific or definitive diagnosis as well as the belief that the assessment of prognostic/predictive factor is not possible or reliable on cytologic specimens. At our institution, FNAB of breast has been practiced for over 25 years with excellent cytologic-histological correlation. This practice has been beneficial not only for patients, but also for training physicians since nowadays a very small number of centers in the United States still routinely perform fine needle aspiration as a diagnostic tool in breast cases. To assess the diagnostic accuracy of FNAB in palpable breast lesions, we reviewed our experience during an 8-year-period and compared fine needle aspiration results with follow-up surgical specimens. From the cytology point of view, the lesions were divided as negative/benign, atypical/suspicious, positive, and insufficient. Only cases performed by pathologists were included. A total of 1,583 cases were retrieved from our archives. A definitive malignant diagnosis was reached in 357 cases. One-hundred and thirty-nine cases were classified as atypical/ suspicious, 135 cases had insufficient cells for establishing a diagnosis, and 952 were categorized as negative. A total of 408 follow-up surgical specimens were available for comparison with cytologic results. There were 19 false-negative, and no false-positive results were found. The majority of false-negative results were secondary to sampling errors. In 93% of the malignant cases, there was enough material obtained in cytological specimens to perform prognostic/predictive factors studies. Our data proves once again that FNAB is a reliable method for the initial evaluation and diagnosis of palpable masses of the breast. In addition, it also has the ability of providing necessary prognostic/predictive information, particularly for patients that may undergo neoadjuvant therapy.     

Diagnostic value of telomerase expression in breast fine-needle aspiration biopsies

Fine-needle aspiration biopsy (FNAB) of breast is a minimally invasive sampling procedure with a proven value in the initial evaluation of patients with palpable breast lesions. FNAB is a simple, cost-effective, and relatively nontraumatic procedure that has replaced open surgical biopsy in majority of academic institutions across the world. There are, however, inherent limitations in the ability of FNAB to reliably diagnose small percentage of cases that are difficult to diagnose by cytomorphology alone and require excisional biopsy. This shortcoming may be minimized if the morphology can be complemented by a reliable diagnostic adjunct. This retrospective study was designed to assess the added value of telomerase immunostain in interpretation of breast FNABs. Telomerase is a ribonucleoprotein enzyme that has been shown to be activated in different malignant tumors, including breast cancer. Immunocytochemical detection of this molecular marker on cytologic smears and cellblocks may be helpful for interpretation of FNAB specimens. In our retrospective study, we found that 56% of the malignant breast cases (28/50) showed positive telomerase immunostaining while only 4% of the negative cases (2/50) stained with telomerase (positive predictive value: 93%, negative predictive value: 69%). Expression of telomerase on highly suspicious breast fine-needle aspirations may upgrade the diagnosis to malignancy. However, a negative telomerase cannot exclude the possibility of carcinoma.     

Role of fine-needle aspiration biopsy in breast lesions: Analysis of a series of 4,110 cases

From January of 1990 to December of 1992, 6,954 consecutive cytologic breast fine-needle aspiration biopsies (FNAB) were performed at the Laboratory of Pathology of Sant'Anna Hospital in Turin. Of these cases 62% were solid nodes, 35% were cystic nodes, and 2.7% were nonpalpable breast lesions (stereotaxic or ultrasound guided FNAB). We verified 4,110 cases: 913 cases underwent surgery and 3,197 were evaluated clinically, and/or cytologically, and/or with mammography at least 1 yr after the first diagnosis, or checked with the database of the Tumor Registry of Turin. In our series the FNAB sensitivity was 94.6%, specificity was 99.9%, accuracy was 98.8%, inadequate samples were 6.4%, false-negative rate was 1.4%, and false-positive rate was 0.3%. Our results indicate that the use of cell block improves sensitivity (from 85.2 to 94.6%) and strongly reduces false-negative results (from 3.9 to 1.4%). We conclude that FNAB is a discriminant procedure to the surgical biopsy in cases with clinical, ultrasound, or mammographic low or intermediate suspect, contributing to allow a high malignant/benign surgical biopsy rate and to reduce the need for frozen section diagnosis and medical costs. Diagn. Cytopathol. 1998;18:462–467. © 1998 Wiley-Liss, Inc.     

乳腺三维断层摄影与乳腺彩超在乳腺疾病诊断中的效能对比

【摘 要】 目的:研究数字乳腺三维断层技术（DBT）和乳腺超声在诊断乳腺病变效能的不同以及联合应用对于乳腺诊断的价值。 方法:收集1 065例乳腺病变患者,其中333例有完整的病理检查资料。以乳腺影像报告和数据系统（BI-RADS）分类为标准,分析DBT、超声、DBT+超声在乳腺病变诊断中的分布差异。根据333例病理结果,比较3种诊断模式的诊断效能。 结果:DBT与超声的BI-RADS分布有显着性差异（P=0.001）,DBT与DBT+超声或超声与DBT+超声的BI-RADS分布无显著性差异（P=0.258, 0.394）。3种诊断模式均可明显区分恶性和良性乳腺病变（P<0.001）。多组独立样本Kruskal-Wallis秩和检验分析显示3种诊断模型存在差异（[χ2]=14.982, P=0.001）。DBT的特异性、误诊率、准确性和阳性预测值明显优于超声。超声显示囊性病变优于DBT,且超声对确定良性肿块的敏感性优于DBT。DBT+超声的特异性为99.5％,误诊率为0.5%,阳性预测值也达到99%。DBT+超声的检查模式优于单独使用DBT或超声。 结论:与单独的DBT或超声相比,DBT和超声的组合可以提高乳腺病变的诊断效能。     

Fibroadenomas with atypia: causes of under- and overdiagnosis by aspiration biopsy.

Fibroadenoma (FA) is a common benign breast lesion frequently sampled by fine-needle aspiration biopsy (FNAB). Although the cytologic diagnosis is straightforward in most cases, cellular discohesion and atypia in FAs may lead to falsely atypical or positive FNAB diagnoses. Conversely, some adenocarcinomas mimic a fibroadenomatous pattern on FNAB, resulting in a false-negative diagnosis. We reviewed the cytologic and histologic findings in 25 cases with a preoperative FNAB diagnosis of FA, wherein excision was recommended based on atypia. Our aim was to analyze the spectrum of changes causing under- or overdiagnosis in such cases. The smears were assessed for cellularity, cellular discohesion, presence of dissociated intact cells and nucleoli, nuclear pleomorphism, oval bare nuclei, and stromal fragments. The histologic findings were correlated with FNAB features. At excision, 88% of FAs classified as atypical on FNAB were benign (FA with ductal hyperplasia and lactational change, myxoid FA, and other fibroepithelial lesions). Differentiating myxoid FA from colloid carcinoma was difficult due to the abundance of extracellular mucin in which the dissociated epithelial cells were floating. Two (8%) cases were carcinomas on excision; the reasons for underdiagnosis in one case reflected sampling, and in the other, interpretative error. There was one (4%) benign phyllodes tumor which lacked stromal fragments and single stromal cells on FNAB smears. The lesion was called atypical, based on the epithelial discohesion on the smears. We conclude that the majority of FAs with atypia on FNAB are benign lesions. Considering the grave consequences of a false-positive cytologic diagnosis, we recommend a conservative approach in interpreting FNAB smears which overall display a fibroadenomatous pattern.     

压迫式弹性成像与声脉冲辐射力成像技术在乳腺肿瘤良恶性鉴别中的价值比较

目的:探讨分析压迫式弹性成像（CE）与声脉冲辐射力成像（ARFI）技术在乳腺肿瘤良恶性鉴别中的价值。方法:选择门诊或住院行超声检查发现的有乳腺肿块患者71例共89个病灶,经病理组织学确认良性病灶57个,恶性病灶32个。对各病灶进行彩色多普勒超声检查,并采取CE及ARFI技术,分别计算病灶弹性应变率比值（SR）及声触诊组织定量（VTQ）值,采用ROC曲线分析SR、VTQ对良恶性肿瘤的诊断效能。结果:恶性组病灶VTQ值与SR值均显著高于良性组（P<0.05）。采用ROC曲线分析VTQ、SR对乳腺良恶性肿瘤诊断效能,VTQ诊断曲线下面积（AUC）为0.918,95% CI为0.871~0.980（P<0.05）,最佳截断值为3.97,在此最佳截断值下,VTQ诊断敏感性94.64%、诊断特异性90.63%;SR诊断AUC为0.899,95% CI为0.854~0.956（P<0.05）,最佳截断值为4.12,在此最佳截断值下,SR诊断敏感性92.86%、诊断特异性84.38%。VTQ和SR诊断敏感性、特异性比较差异无统计学意义（P>0.05）。结论:两种超声诊断技术对乳腺良恶性肿瘤均具有较高的诊断价值,其诊断效能相似,临床上可联合使用,以实现优势互补,提高对乳腺癌的早期检出率。     

Usefulness and problems of endoscopic ultrasonography in prediction of the depth of tumor invasion in early gastric cancer

The objectives of this study were to evaluate the accuracy of endoscopic ultrasonography (EUS) in local and regional staging of early gastric cancer, to analyze the factors influencing the accuracy of EUS, and to reveal the usefulness and problems of EUS in pre-treatment staging of gastric cancer. We examined 105 lesions in 104 patients with histologically confirmed gastric cancer and retrospectively evaluated them with EUS. The diagnostic accuracy, sensitivity, and specificity of EUS were determined by comparing the pre-treatment EUS with the postoperative histopathological findings. The overall diagnostic accuracy of EUS for the depth of cancer invasion was 86%. The overall sensitivity and specificity were 60% and 96%, respectively. The accuracy significantly declined in lesions located in the upper-third of the stomach (70%). Type 0-I lesions tended to be over-staged (12&), and the upper-third lesions tended to be under-staged (23%). The accuracy significantly declined in differentiated adenocarcinoma with massive submucosal invasion (56.5%). EUS is useful for evaluating the depth of gastric cancer invasion which determines the feasibility of endoscopic treatment. However, it is noteworthy that the diagnostic accuracy of the invasion depth diminished for lesions in the upper third of the stomach.     

Diagnostic value of imprint cytology during image-guided core biopsy in improving breast health care

The aim of this study was to investigate the accuracy of imprint cytology (IC) of breast core biopsy under ultrasound guidance and to assess the value of a rapid on-site preliminary diagnosis of breast lesions. A total of 437 breast core needle biopsies under ultrasound guidance with touch imprint cytology, histology, and final diagnosis were reviewed. These cases were collected from archived files at our institution. Of 437 core biopsies, IC classified 241 (55%) as benign; 22 (5%) as probably benign; 28 (6%) as probably malignant; 107 (25%) as malignant; and 39 (9%) as inadequate for IC diagnosis. Histological classifications for the 437 cases were: 285 (65%) benign; 132 (30%) malignant; 16 (4%) atypical hyperplasia; and 4 (1%) inadequate specimen. The overall sensitivity and specificity indices of IC were 95% and 96%, respectively, for benign and probably benign lesions vs malignant and probably malignant breast lesions. The overall positive and negative predictive values were 91% and 97%, respectively. The overall accuracy was 95% (379 of 398 cases, excluding specimens inadequate for IC diagnosis). IC of ultrasound-guided core needle biopsy provides a rapid and reliable preliminary diagnosis for breast lesions; it also serves as a means to verify the adequacy of biopsy specimens and to optimize the biopsy procedure. Use of IC may reduce anxiety in patients with benign lesions and expedite the diagnosis and assessment of treatment options in patients with breast cancer.     

Diagnosis of occult thyroid carcinoma by ultrasonography

The increased sensitivity of many imaging devices has increased the identification of asymptomatic nodules in the thyroid gland. In this study we investigated the actual incidence of nonpalpable thyroid nodules and occult carcinoma in women. Between January and June 2003, among the women who were scheduled to undergo breast ultrasonography, 697 without palpable thyroid nodules were screened for thyroid nodules. They were classified into four categories according to ultrasonographic findings: negative, benign, indeterminate and malignant. Ultrasound-guided fine-needle aspiration biopsy (FNAB) was carried out for all malignant lesions and for some of the benign and indeterminate ones. The nodule detection and malignancy rates were determined and the effectiveness of ultrasonography as a diagnostic tool was also investigated. Out of the 697 subjects, 246 (35.3%) were found to have thyroid nodules. The malignancy detection rate based on the FNAB results, including both suspicious and malignant groups, was 3.6% (25/697) for all subjects. In addition, 3.0% (21/697) of all the women were confirmed to have thyroid cancer by surgery. The sensitivity of sonographic classification was increased from 80% to 100% when the indeterminate class was added to the malignant one, although this decreased the specificity from 91.7% to 33.3%. In conclusion, high-resolution ultrasonography detected a high percentage of malignant nodules. Ultrasonography can augment its value by guiding FNAB, in addition to providing diagnostic images.