Expert opinion: Reporting needle core biopsies of breast carcinomas

Many breast carcinomas are now diagnosed in needle core biopsies, after either mammographic detection or symptomatic presentation. There is dispute, however, about the range of information that should be included in the diagnostic report of these small and possibly unrepresentative samples. Is it sufficient to simply report the presence of carcinoma, in situ or invasive? Or should the histopathologist give a more detailed report including features of prognostic and predictive significance? If so, what is the evidence that the further information is, first, of clinical benefit and, second, not unreliable because of sampling variability? To address the question ‘What should be included in reports of needle core biopsies of breast carcinomas?’ contributions were invited from authors in the USA and the UK.     

Bilateral ovulation fossa inclusion cysts in Miranda jennets

Multiple cysts ranging from 2–111 mm were noted bilaterally in the ovulation fossa of 11 mature Miranda jennets. These ovulation fossa inclusion cysts (OFICs) were lined by a simple low to columnar epithelium that included many ciliated cells. Although most cases were incidental findings, two of the jennets were presented with reduced fertility. Extensive cyst formation could have been responsible for the reproductive problems because they replaced most of the ovarian parenchyma. Due to their close proximity to the ovulation fossa, the OFICs may have mechanically interfered with passage of eggs into the oviduct. OFICs are histologically common in equids, but are reported uncommonly as gross lesions in either mares or jennets. Ovarian inclusion cysts are associated with neoplasia in women; however, these OFICs showed no evidence of epithelial hyperplasia or cellular atypia and no evidence of independent growth, therefore they were considered to be non-neoplastic. The bilateral occurrence and high incidence of OFICs in Miranda jennets, a breed with limited genetic variability, suggests that the lesion has a genetic causation.     

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.     

Diagnostic reliability of histological and cytological fine needle biopsies from focal liver lesions

In 175 consecutive cases of ultrasonically detected focal liver lesions both cytological and histological fine needle biopsies were performed using two different 0.6 mm needles. The cytological and histological material was evaluated blindly and separately by two examiners, who had no access to clinical data. In 65 cases a reliable final diagnosis as defined by autopsy or surgical biopsy within 6 months could be reached. Eleven cases of benign liver lesions were correctly classified by the two examiners by both cytological and histological fine needle biopsies, resulting in a predictive value of 100% for a malignant diagnosis. The predictive value for a benign diagnosis was 85% for both examiners' evaluation of cytological fine needle biopsies, while it was 73% and 85%, respectively, for histological fine needle biopsies. At reevaluation both sampling error and difficulties in interpretation of biopsies of poor quality were responsible for the false benign diagnosis. The origin of the primary tumour was correctly diagnosed in about 50% of the cases by both techniques. Correct tumour typing could most often be made by both methods in cases of hepatocellular carcinoma, breast carcinoma, colonic carcinoma and small cell carcinoma of the lung.     

Construction of tissue microarrays from core needle biopsies – a systematic literature review

In some clinical circumstances, core needle biopsy (CNB) may be the only source of material from cancer tissue for diagnostic use. The volume of tissue available in a CNB is low, and opportunities for research use can therefore be limited. The tissue microarray (TMA) principle, if applied to the use of CNBs, could facilitate research studies in circumstances where CNB specimens are available. However, various challenges are expected in applying such a technique in CNBs, which has limited their use in research. We therefore conducted a systematic review of the literature on this subject. A systematic search was carried out with CINAHL, EMBASE, the Cochrane library, and MEDLINE, to identify studies that have primarily developed methods for constructing TMAs from CNBs. Eight studies were found to meet the inclusion criteria; six of these employed the vertical rearrangement technique, and two used multiple layers of biopsy tissue. Representation of the CNB was significantly influenced by the quantity of tumour cells present in the original biopsy and the degree of heterogeneity of biomarker expression. This review shows that technologies have been developed to enable construction of TMAs from CNBs. However, challenges remain to improve amplification and representation.     

2467例穿刺标本病理诊断影响因素的评价与分析

目的对多种引导方式下、多部位穿刺标本的病理诊断影响因素进行评价与分析。方法收集2467例在多种引导方式下多部位穿刺并进行组织学检查的病例，对其病理诊断结果的确切程度进行分级，并对某些影响诊断确切程度的因素(年龄、性别、穿刺部位、引导设备、标本性状、结果性质)进行了多元逐步Logistic回归分析。结果获取目视下穿刺病例110例，超声引导下1845例、X线引导下138例．CT引导下208例，超声定位后胸膜针穿刺166例，并对各例病理诊断的确切程度进行了分级。剔除骨、颅内、前列腺、胸膜等部位后．Logistic回归分析显示年龄(回归系数为-0．0216，Wald x^2=33．9741，P=0．0001)、引导方式(回归系数为0．1538．Wald x^2=9．5970，P=0．0019)、穿刺部位(回归系数为0．0587，Wald x^2=11．1917．P=0．0008)、病灶大小(回归系数为-0．0647，Wald x^2=10．8009，P=0．001)、标本性状(回归系数为-0．028．Wald x^2=1．1101，P=0．2921)均影响穿刺组织病理诊断的确切程度．被列入回归方程。结论影像引导的穿刺活检对全身各器官都可进行，患者的年龄、引导方式、穿刺部位、病灶大小、标本的性状是影响病理诊断确切程度的主要因素。     

A comparison of the use of the 'Tru-Cut' needle and fine needle aspiration cytology in the pre-operative diagnosis of carcinoma of the breast

Two methods of obtaining a pre-operative diagnosis of carcinoma of the breast are compared. Tru-Cut needle biopsy was carried out on 368 consecutive patients with palpable breast lumps, and both Tru-Cut biopsy and fine needle aspiration cytology were performed during part of this study on 163 of the patients. A final histological diagnosis was obtained in each patient, at excision biopsy or mastectomy. There were 278 patients with carcinoma and 90 with benign breast disease. A correct positive diagnosis of carcinoma was made by the Tru-Cut method in 73.5% of cases, but in only 52% of cases by aspiration cytology. More importantly, there were no false positive diagnoses of carcinoma with Tru-Cut biopsy, but five cases of benign breast disease were incorrectly diagnosed as carcinoma by aspiration cytology. It is concluded that Tru-Cut biopsy is sufficiently reliable to be able to proceed direct to mastectomy following a positive diagnosis of carcinoma, in distinction to aspiration cytology with which an unacceptably high number of false positives occurs. The benefits of a pre-operative Tru-Cut biopsy diagnosis are identified.     

Standardized reporting of histological diagnoses for non-neoplastic liver conditions in needle biopsies

The importance of standardizing surgical pathology reports is emerging from the literature. The use of checklists has recently been proposed for diagnosing the major tumour types, but no attention has been given to non-neoplastic conditions. In this paper a checklist for standard reports of liver needle biopsies for non-neoplastic conditions is presented.     

Assessing intraductal proliferations in breast core needle biopsies

Intraductal proliferations of the breast comprise a heterogeneous group of epithelial proliferations confined to the ductal and lobular system of the breast parenchyma. The correct interpretation and categorization of such lesions can be challenging, especially on core needle biopsy, but are critical for appropriate clinical management as this determines whether surgical excision is or is not required. In this paper we aim to review the histologic criteria and terminology for the spectrum of intraductal proliferative lesions. We will discuss the key morphologic features and diagnostic mimics of usual ductal hyperplasia, atypical ductal hyperplasia, and ductal carcinoma in situ, and provide practical guidelines for interpretation in core needle biopsy specimens.     

乳腺针吸细胞学假阴性诊断分析

目的 :提高乳腺癌针吸细胞学诊断的准确性。方法 :对 72 31例乳腺肿块进行针吸细胞学检查 ,获取病理组织学对照有744例 ,并作统计分析。结果 :本组针吸细胞学诊断敏感性 93 6 7% ,特异性 96 43% ,假阳性率 3 5 7% ,假阴性率 6 33% ,符合率 94 0 9%。结论 :针吸细胞学是乳腺肿块一种重要的辅助诊断方法。肿瘤实质细胞较少或细胞异型性不明显是假阴性诊断的主要原因。注意触诊和重复针吸是减少假阴性的主要措施     

Fine‐needle aspiration of metastatic melanoma presenting as bilateral breast cysts

Melanoma is the second most common non‐hematopoietic malignancy after carcinomas to metastasize to the breast and often appears as a well‐circumscribed, dense nodule on imaging. Although metastatic lesions presenting as bilateral cysts have been reported, this presentation is not common and may mimic benign breast cysts. We present a challenging case of metastatic melanoma presenting as bilateral breast cysts with spindled cytomorphology in a patient with a history of mammary carcinoma. Discordance between the spindled cytomorphology and the morphology of the core biopsy, which was similar to the patient's primary breast cancer, allowed for entertainment of other tumors and disease processes. Confirmatory immunostaining of the cytology material with HMB‐45 was important to establish the diagnosis of metastatic melanoma. Diagn. Cytopathol. 2017;45:446–451. © 2017 Wiley Periodicals, Inc.     

Percutaneous cutting needle biopsies for histopathological assessment and sperm retrieval in men with azoospermia

BACKGROUND: Twenty-three men (45 testes) with azoospermia underwent percutaneous testicular biopsy under local anaesthesia. METHODS: In all but one of the 45 testes two biopsies were taken close to each other, one with a 16 gauge (n = 44) and another with a 14 gauge (n = 45) cutting needle, both with a 19 mm notch. Three quarters of the tissue was used for histopathological assessment and one quarter for direct microscopy. RESULTS: The histopathological findings were similar between the two needles. The observations with direct microscopy corresponded with the histopathological assessments concerning the presence of mature spermatids in 41 of 45 (91%) biopsies using the 14 gauge and in 40 of 44 (91%) biopsies using the 16 gauge needle. There were no post-operative complications except for minimal pain and minor local swelling. CONCLUSIONS: Percutaneous material retrieved using 16 gauge and 14 gauge needles is sufficient for histopathological assessment, and the two needles are equally reliable for testicular sperm retrieval. However, needle biopsy with one puncture may not be representative of the entire testis.     

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.     

甲状腺髓样癌原发及转移灶细针穿刺细胞学诊断

目的：提高甲状腺髓样癌（medullary thyroid carcinoma,MTC)细针穿刺（fine needle aspiration,FNA)细胞学诊断的准确性。方法：回顾分析14例组织学证实的MTC FNA标本及免疫细胞化学结果。总结10项细胞形态学特征;涂片背景、胶质、淀粉样物质,细胞数量,细胞排列结构,细胞异型性,细胞形状,有无双或多核细胞,核染色质以及有无核仁。结果：14例MTC主要细胞学特点为：（1）细胞呈浆细胞样和（或）梭形,前者更多见;（2）“盐和胡椒”样核染色质;（3）细胞轻至中度多形性,间有散在大细胞;（4）常见双核/多核细胞;（5）细胞呈散在或疏松团状排列;（6）核仁少见;（7）背景中基本无胶质,淀粉样物质并非多见,3例降钙素标记为阳性。结论：FNA可有效地术前诊断MTC,瘤细胞呈浆细胞样和（或）梭形,具神经内分泌肿瘤特点（包括“盐和胡椒”样核染色质,细胞散在分布倾向,细胞轻至中度多形性并间有少量大细胞及双核/多核细胞）,核仁和胶质少见,可作为诊断依据。淀粉样物质非诊断必须,有选择地应用免疫细胞化学可提高FNA的诊断准确性。     

Value of combined use of fine‐needle aspiration and core needle biopsy in palpable breast tumors performed by pathologist: Institut Curie experience

The aim of this study was to determine the accuracy of fine‐needle aspiration (FNA) and core needle biopsy (CNB) for palpable breast tumors (PBTs). FNA and CNB of 492 PBTs from 477 patients were analyzed. Tumors were malignant in 473 cases and benign in 19 cases. There was a strong correlation (P > .05) between FNA and CNB in terms of malignancy. Among 473 malignant tumors, FNA had better accuracy and less unsatisfactory results (95.6%; 2.7%) than CNB (94.9%; 4.9%). Among 19 benign tumors, CNB was accurate in 100% compared to 94.7% using FNA. There were only two (0.4%) cases where result was unsatisfactory by both FNA and CNB. NPV was 56.3% for FNA, 43.2% for CNB, and 95.0% for FNA and CNB combined. Sensitivity was 97.0% for FNA, 94.7% for CNB, and 99.8% for FNA and CNB combined. PPV and specificity was 100% for FNA and CNB both separately and combined. Combined use of FNA with CNB is an optimal diagnostic method for PBTs. In our opinion, this should be recommended as standard for diagnosis of PBTs.     

Diagnostic yield of biopsies of cervical lymph nodes using a large (14‐gauge) core biopsy needle

The purpose of this study was to assess retrospectively complications and diagnostic yield of core needle biopsy (CNB) of cervical lymph nodes using 14‐gauge as sole needle bore. During a 10‐year period ultrasound (US)‐guided CNB, using a 14‐gauge Tru‐Cut needle (non‐advancing), was performed in 140 consecutive cases (135 patients, aged 8–88 years) when a detailed histological diagnosis was required to guide therapy. CNB findings were consistent with the final diagnosis in 129 of the 140 cases, comprising 36 benign lesions, 40 metastases, and 53 lymphomas (40 NHL and 13 HL) of which subclassification (WHO criteria) was partial in 5NHL, and complete in 35 (87.5%) NHL and 13 HL (100%), including all 7 lymphomatous nodes with short‐axis diameter ≤1.0 cm. Two lymphomas were falsely interpreted as reactive hyperplasia. Nine samples (6.4%) were inadequate for histopathological analysis. One patient experienced pain in an arm lasting 3–4 days. No other immediate or delayed complications were diagnosed. A 14‐gauge may be used safely as the sole needle bore in US‐guided CNB of cervical lymph nodes, rendering samples sufficient for full subtyping in lymphoma, even in the smallest nodes.     

A comparative study on ultrasound-guided elite,Mammotome, and core needle biopsy for diagnosing malignant breast masses

IntroductionThe present study aims to clarify the advantages and disadvantages of elite biopsy, to provide a reference for selecting the puncture method.Material and methodsA total of 802 patients with a BI-RADS grade ≥ 4, as evaluated by the molybdenum target, and measurable lesions revealed by colour Doppler ultrasound, who were admitted at our department from January 2017 to January 2018, were enrolled in the present study. These patients were randomly divided into three groups: elite, Mammotome and core needle biopsy groups. The pathological underestimation rate, diagnostic accordance rate, haematoma incidence rate, and costs of these three biopsy methods were compared.ResultsThe difference in diagnostic accordance rates between the elite biopsy group and core needle biopsy group was statistically significant (98.9% vs. 94.7%, p = 0.003), as well as between the Mammotome biopsy group and core needle biopsy group (99.6% vs. 94.7%, p < 0.001). The difference in pathological underestimation rates between the elite biopsy group and core needle biopsy group was statistically significant (7.2% vs. 37.3%, p < 0.001), as well as between the Mammotome biopsy group and core needle biopsy group (1.6% vs. 7.2%, p < 0.001). The difference between the Mammotome biopsy group and elite biopsy group was not statistically significant. The incidence of haematoma in the Mommotome, elite, and core needle groups was 15.9%, 13%, and 21.7%, respectively (13% vs. 21.7%, p = 0.021).ConclusionsElite biopsy has a low rate of pathological underestimation and low incidence of haematoma, can improve the breast conserving rate, and has an affordable cost. As a biopsy method with high accuracy, safety, and economy, elite biopsy can be widely used in clinics.