B超引导空芯针穿刺活检对于乳腺肿块诊断作用的分析

目的：评价B超引导空芯针穿刺活检（core needle biopsy,CNB）在可触及的乳腺肿块中的临床应用价值,同时讲述操作中的技术事项。方法：回顾分析可触及肿块的乳腺疾病住院患者的临床和病理资料,总结B超引导CNB的适应证、优缺点、注意点。结果：CNB的敏感性为94.85%,假阴性为5.15%;病理低估为5.83%;诊断符合率为89.32%。14Gauge穿刺针的标本数应该是3根以上的合格标本;行ER、PR、neu检测的患者,需取合格穿刺标本4根以上。结论：对于临床可触及的乳腺肿块,该检测方法有较高的临床应用价值。B超引导CNB适用于超声发现的乳腺病灶。B超引导的CNB的优点是明显缩短手术时间和避免了手术切除肿块时可能带来的肿瘤播散。从术中冰冻病理到术前明确诊断是一种治疗模式的转变。     

B超引导空芯针穿刺活检对于乳腺肿块诊断作用的分析

目的:评价B超引导空芯针穿刺活检(core needle biopsy,CNB)在可触及的乳腺肿块中的临床应用价值,同时讲述操作中的技术事项.方法: 回顾分析可触及肿块的乳腺疾病住院患者的临床和病理资料,总结B超引导CNB的适应证、优缺点、注意点.结果:CNB的敏感性为94.85%,假阴性为5.15%;病理低估为5.83%; 诊断符合率为89.32%.14Gauge穿刺针的标本数应该是3根以上的合格标本;行ER、PR、neu检测的患者,需取合格穿刺标本4根以上.结论: 对于临床可触及的乳腺肿块,该检测方法有较高的临床应用价值.B超引导CNB适用于超声发现的乳腺病灶.B超引导的CNB的优点是明显缩短手术时间和避免了手术切除肿块时可能带来的肿瘤播散.从术中冰冻病理到术前明确诊断是一种治疗模式的转变.     

A case of mucinous carcinoma of the breast in which needle tract seeding was diagnosed by preoperative diagnostic imaging

Herein we report a 62-year-old woman with an excisable breast tumor in whom needle tract seeding was suspected during preoperative ultrasound and magnetic resonance imaging (MRI). A tumor of the right breast was observed during initial examination, and she was referred to our hospital after fine-needle aspiration cytology led to diagnosis of breast cancer, even though core needle biopsy results were negative. Mammography showed a high-density mass with a portion of the margin exhibiting very fine serrations. Ultrasonography revealed a circular mass with a border that was indistinct in some regions, and a hypoechoic band that extended from the tumor toward the skin. A mass was observed on MRI, with a linear enhancement extending on the skin side, and needle tract seeding was suspected. Fine-needle aspiration cytology revealed malignancy, and the histological appearance was consistent with mucinous carcinoma. T1cN0M0 stage I breast cancer was diagnosed, and wide excision and sentinel lymph node biopsy were performed. The skin directly above the tumor was concurrently excised to remove the biopsy puncture site. Histopathological diagnosis confirmed mucinous carcinoma, with the tumor observed to extend linearly into the subcutaneous adipose tissue in a pattern corresponding to the biopsy puncture site. The stump of the excised breast was negative for cancer cells. The possibility of tumor seeding must be considered during fine-needle aspiration cytology and biopsy. As demonstrated in this case, diagnosis of such seeding through preoperative imaging may enable extraction of the entire lesion, including the needle tract.     

Unsuccessful preoperative biopsies, fine needle aspiration cytology or core needle biopsy, lead to increased costs in the diagnostic workup in breast cancer

Correct preoperative diagnosis of a breast lesion is essential for optimal treatment planning. Our aim was to compare feasibility of fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) in diagnosis of breast lesions. The special aim was to evaluate the extra costs and delay in surgical treatment due to unsuccessful preoperative biopsies. Diagnostic work-ups in 572 patients with 580 breast lesions were retrospectively evaluated. FNAC was the first biopsy method for 339 lesions, CNB for 241 lesions. The postoperative diagnosis was malignant for 503 lesions. The preoperative rate of definitely malignant diagnosis was 67% (194/289) for FNAC and 96% (206/214) for CNB (p < 0.0001), and 95% and 99%, respectively (p = 0.0173), when also suspicious findings were included. In patients with FNAC, an additional needle biopsy was performed for 93 and a surgical biopsy for 62 lesions. In the CNB group, a subsequent CNB was performed for 2 and a surgical biopsy for 33. The frequent need for additional biopsies raised the total expenses of FNAC over those of CNB. Multiple biopsies may also delay cancer surgery. It is therefore recommended to use CNB as the initial needle biopsy method.     

Core wash cytology of breast lesions by ultrasonographically guided core needle biopsy

Previous studies demonstrated that core wash cytology by stereotactic needle biopsy was useful for the immediate diagnosis of breast lesions. The purpose of this study was to assess the accuracy of core wash cytology of breast lesions by ultrasonographically (US) guided core needle biopsy (CNB). US-guided 18-gauge CNB was performed in a series of 458 cases. Each CNB sample was washed in saline solution. Core wash cytology of the washed core material was performed on material obtained by saline solution lavage of the fragments using a cytocentrifuge. The cytological diagnoses were divided into five categories: benign, atypical/indeterminate, suspicious/probably malignant, malignant, and unsatisfactory, which then were compared with the CNB results. The cytological diagnoses of the 458 cases were as follows: 106 lesions (23.1%) were benign, 28 lesions (6.1%) were atypical/indeterminate, 42 lesions (9.2%) were suspicious/probably malignant, 88 lesions (19.2%) were malignant, and 194 lesions (42.4%) were unsatisfactory. The core wash cytology had a sensitivity of 89% (141 of 158), and a specificity of 72% (76 of 106). The CNB showed 143 of 194 unsatisfactory samples (74%) to be benign, three to be high-risk, and 48 (25%) to be malignant. Unsatisfactory samples were obtained from significantly more benign than malignant lesions. In conclusion, the high rate of insufficient samples for core wash cytology of breast lesions by US-guided CNB makes its use impractical in this setting. This technique is not useful for immediate diagnosis of breast lesions by US-guided CNB.     

Two cases of stromal sarcoma, so-called malignant fibrous histiocytoma of breast treated with reduction surgery

CASE 1: A 64-year-old woman with right breast cancer had a partial mastectomy and radiotherapy four years ago was admitted to our hospital because of right breast mass. The vacuum associated biopsy of tumor resulted in breast sarcoma, thus a nipple-spearing mastectomy was performed. The final histological diagnosis was stromal sarcoma, and was identical to histological findings of malignant fibrous histiocytoma. Three months after the operation, a chest wall recurrence appeared. Although tumor resection with latissimus dorsi flap was performed, there were pleural dissemination and malignant pleural effusion. She died six months after the first surgery. CASE 2: A 60-year-old woman was admitted to our hospital because of left breast mass, but she refused a further clinical examination. She readmitted fourteen months later due to a huge sized left breast mass with necrosis and smelling discharge. CT scan showed a huge tumor of left breast and multiple lung metastases. Biopsy of the tumor resulted in breast sarcoma. Total mastectomy with split thickness skin grafting was performed. The final histological diagnosis was identical to the first case. A local recurrence appeared thirty days after the operation, and she died fifty-one days after the operation.     

彩超引导下空芯针穿刺在乳腺肿块诊断中的意义

目的:评价彩超引导下空芯针穿刺活检（US-CNB）在乳腺肿块诊断中的临床意义。方法:回顾性分析宿州市立医院肿瘤外科2011年1月至2014年6月行空芯针穿刺活检病人120例,对空芯针穿刺活检和切除活检标本的病理组织学诊断进行比较和分析。结果:120例乳腺疾病病人经空芯针穿刺活检组织学诊断乳腺癌为90例,7例假阴性,假阴性率为5.8%。US-CNB 与切除活检的病理诊断符合率为94.2%,无显著性差异（P＞0.05）,空芯针穿刺结果与肿瘤性质、部位、患者年龄、钙化等因素,无显著性差异（P＞0.05）,与肿瘤大小有显著性差异（P＜0.05）。结论:彩超引导下空芯针穿刺活检是一种敏感性高、特异性强、安全性较高的乳腺病变诊断方法。     

Nodular fasciitis of the breast

We report a case of nodular fasciitis of the breast, which is a rare histological type of breast tumor. A 41-year-old woman had noticed a mass in her right breast. The mass was elastic-hard, 15 mm x 15 mm in size, and located mainly in the upper outer quadrant of the right breast. Mammography demonstrated an oval dense mass with spiculation. Ultrasonography revealed a hypoechoic lesion, 8 mm x 10 mm in size. Fine needle aspiration cytology and core needle biopsy showed no evidence of malignancy. Excisional biopsy was performed. The tumor was characterized by a proliferation of fibroblastic cells. Histologically, the excised tumor was consistent with nodular fasciitis of the breast. Nodular fasciitis should be considered in the differential diagnosis of a mass suspicious for breast cancer.     

A case of pulmonary metastasis from breast cancer following an 18-year disease-free interval that responded to tamoxifen treatment

A 61-year-old woman was admitted to our hospital with an abnormal shadow on chest roentgenogram. She had undergone a radical mastectomy for right breast cancer 18 years previously. Since pleural dissemination was noted at the time of thoracotomy, only tumor biopsy was performed. Although a decisive diagnosis could not be obtained histologically, the tumor resembled breast cancer and the estrogen receptor status was positive. She underwent post-operative chemotherapy and tamoxifen treatment. After tamoxifen treatment, complete response was observed. The patient is now doing well without recurrence about 10 years after thoracotomy. Based on the clinical course, we obtained both a definitive diagnosis and complete remission.     

Survival Outcomes of Patients With Breast Cancer Diagnosed Using Vacuum-Assisted Biopsy: A Nationwide Study From the Korean Breast Cancer Society

PurposeBreast cancer is mainly diagnosed using core needle biopsy (CNB), although other biopsy methods, including vacuum-assisted biopsy (VAB), may also be used. We compared differences in clinical characteristics and prognoses of patients with breast cancer according to biopsy methods used for diagnosis.MethodsA total of 98,457 patients who underwent various biopsy methods (CNB, fine-needle aspiration [FNA], VAB, and excisional biopsy) for diagnosing breast cancer were recruited. Using CNB as a reference, related clinicopathological factors and prognostic differences between biopsy methods were analyzed retrospectively using large-scale data from the Korean Breast Cancer Society Registration System. The associations between biopsy methods and clinicopathological factors were compared using multinomial logistic regression analysis, and the prognoses of patients undergoing the different biopsy methods, as breast cancer-specific survival (BCSS) and overall survival (OS), were compared using the Kaplan-Meier method and Cox proportional hazard model.ResultsUnivariate and multivariate analyses showed that unlike FNA, both VAB and excisional biopsy were significantly associated with tumor size, palpability, tumor stage, and histologic grade as relatively good prognostic factors compared to CNB. In particular, VAB showed lower odds ratios for these factors than excisional biopsy. In the univariate analysis, the prognosis of patients undergoing VAB was better than that of those undergoing CNB with respect to BCSS (hazard ratio [HR], 0.188, p < 0.001) and OS (HR, 0.359; p < 0.001). However, in the multivariate analysis, there were no significant prognostic differences from CNB in both BCSS and OS; differences were only evident for FNA.ConclusionIn this study, we showed that the characteristics of breast cancer differed according to various biopsy methods. Although VAB is not a standard method for breast cancer diagnosis, it showed no prognostic differences to CNB.     

One-day core needle biopsy in a breast clinic: 4 years experience

Many attempts have been made to combine the high diagnostic accuracy and conclusive rate of core needle biopsy (CNB) with the speed of fine needle aspiration cytology in evaluation of solid breast lesions. Multiple hybrid techniques have been developed to achieve this. We describe a cohort of patients for whom we used a relatively new, accelerated method of CNB processing, allowing for a definitive diagnosis the same day. All patients visiting the Radboud University Nijmegen Medical Centre breast clinic during a 4-year period were reviewed to identify all CNBs in this period performed in a same-day diagnosis track. CNB result was compared to post-operative pathology reports when available, and to follow-up when patients were not surgically treated. 1,060 patients underwent CNB of 1,383 lesions, 898 of which in a same-day diagnosis track with a sensitivity of 96.9 % and a specificity of 99.4 %. The inconclusive rate was 9.2 %. For a same-day diagnosis for solid breast lesions, we could give a conclusive diagnosis with accelerated CNB processing in 65 % of our patients requiring CNB. This technique can be used reliably in a same-day diagnosis breast clinic with a very high sensitivity, specificity, and conclusive rate.     

A case of nodular pseudoangiomatous stromal hyperplasia (pash)

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a common microscopic lesion that is found at breast biopsy, and presents with proliferation of the stromal cells and slit-like pseudovascular spaces with endothelial-like spindle cells. In contrast, nodular PASH is relatively rare. We report here a case of nodular PASH with multiple palpable masses. A 49-year-old woman who had experienced gradual enlargement of her breasts for 13 years noticed an elastic but firm palpable mass in her breast. We were able to detect 7 masses in her right breast and 2 in the left. Ultrasonography and mammography demonstrated nonspecific findings, and FNA and CNB did not establish a diagnosis. An excisional biopsy was performed, and the pathological findings revealed nodular PASH. Eighteen months after the excisional biopsy, the size of the nodules and the whole breast had decreased remarkably. While the possibility of a change in the hormonal background or the influence of drugs was considered, we were not able to reach a single specific conclusion regarding the pathogenesis.     

A case of non-palpating breast cancer with huge lymph node metastasis

We report a case of non-palpating breast cancer with huge lymph node metastasis. The patient was a 58-year-old woman who had a huge tumor at her right armpit. The tumor was 4 cm in diameter. Aspiration biopsy cytology for the tumor was performed. The diagnosis is Class V. Mammography showed an ill-defined mass at her right breast. Ultrasonography revealed a low echoic mass at the C area of her right breast. A core needle biopsy for the breast tumor led to a diagnosis of an invasive ductal carcinoma positive for estrogen receptor and progesterone receptor, and negative for HER2/neu protein expression. She received 4 cycles of CEF (E: 60 mg/tri-weekly) plus 12 cycles of paclitaxe (l80 mg/weekly). After chemotherapy, she received muscle preserving mastectomy plus axillary lymph nodes dissection. In histopathology, there were no carcinoma cells in resected breast tissue and resected lymph nodes. Therefore, the effect of chemotherapy was diagnosed as a pathological complete response. After operation, she was administered aromatase inhibitor. The patient has been well and remained disease-free during a follow-up period of 6 years.     

真空辅助活检术与空心针穿刺活检术对乳腺疾病诊断价值的Meta分析

目的评价真空辅助活检术（vacuum-assisted biopsy,VAB）与空心针穿刺活检术（core needle biopsy,CNB）对乳腺疾病的诊断价值。方法检索Pub Med、Cochrane Library、CNKI、维普数据库、万方数据库等并收集有关VAB与CNB对乳腺疾病诊断的相关文献,按预定的标准进行筛选,对纳入研究进行质量评价,并提取相应指标完成Meta分析。结果共纳入5个临床研究,包括1 741例患者。Meta分析表明,相较于CNB组,VAB组对乳腺肿瘤活检的诊断敏感性较高（P=0.003）,漏诊率较低（P=0.0005）,诊断低估率较低（P=0.0006）;两组诊断的特异性差异无统计学意义（P=0.69）。结论对于乳腺疾病的活检VAB较CNB有更高的敏感性及更低的漏诊率和低估率。     

A case of multicentric breast cancer in which an effect of neoadjuvant chemotherapy had a disparity

A 61-year-old woman was visited our hospital for a left breast tumor. Ultrasonography (US) demonstrated two tumors comprising a tumor 3.3 cm in diameter in the A area and another one 0.9 cm in diameter in the C area of the left breast, and US-guided core needle biopsy (CNB) was performed. The histological findings showed invasive ductal carcinoma, ER (+)/PR (-)/HER2 (+) in the A lesion and ER (+)/PR (+)/HER2 (-) in the C lesion. At this point in time, US demonstrated a new tumor 1.9 cm in diameter in the outside C area of the left breast, and CNB was performed. The histological findings showed invasive ductal carcinoma, ER (+)/PR (+)/HER2 (-) in the outside C lesion. Chemotherapy was estimated as PD, and an operation was performed (Bt + Ax). Histopathological examination showed pCR in the A lesion, invasive lobular carcinoma in the C lesion and solid-tubular carcinoma in the outside C new lesion. Depend on each subtype, HER2/new targeting trastuzumab therapy, radiation therapy and ER/PR targeting hormone therapy were tried as a post operative treatment.     

Intracystic papillary carcinoma of the breast in male: case report and review of the Japanese literature

We report a case of intracystic papillary carcinoma of the breast in a 62-year-old Japanese man, who came to our hospital complaining of a right subareolar mass. Imaging diagnosis was a cyst with an intracystic component. Since repeated aspiration biopsy cytology was interpreted as a borderline lesion, no additional treatment had been given. Because he wanted the removal of the mass 14 months after his first visit, an excisional biopsy was performed under local anesthesia. Pathological examination revealed the intracystic component to be non-invasive papillary carcinoma. Although the incidence of male breast cancer is approximately 1% of all breast cancer, intracystic papillary carcinoma in the male is very rare. From a review of the literature on this disease in Japanese men, an intracystic component can often be demonstrated by ultrasound. However, it is difficult to confirm malignant cells by aspiration biopsy cytology of cyst fluid. Since some cases have a local relapse, excisional biopsy and long-term follow-up are indicated.      

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.     

Squamous cell carcinoma of the breast in the form of an intracystic tumor

Squamous cell carcinoma of the breast is thought to arise through metaplasia of ductal carcinoma cells. We report a case of pure squamous cell carcinoma of the breast with features of intracystic tumor, which was considered to have arisen from metaplastic squamous epithelial cells lining the cyst wall. A 71-year-old woman presented at our hospital with a 40 x 30-mm mass in the lower outer quadrant of the right breast. Mammography revealed a round, high-density mass, which had a mostly regular but partially irregular margin. Ultrasonography demonstrated a solid tumor with an irregular shape protruding into a cystic space, suspicious of intracystic carcinoma. Aspiration cytology confirmed squamous cell carcinoma. A modified radical mastectomy was performed. Histopathologically, the intracystic tumor was a pure squamous cell carcinoma. The epithelial cells lining the inner cyst wall showed mostly squamous metaplasia, and there was continuity between these cells and the squamous cell carcinoma. 13 months later, the patient is free of disease with no adjuvant therapy.     

A case of femoral artery pseudoaneurysm occurring in the site of a reservoir port for hepatic arterial infusion

A 73-year-old man underwent partial hepatic resection (55) for metachronous metastatic liver tumor from cecal cancer in November 2005. A reservoir port for hepatic arterial infusion (HAI) adjuvant chemotherapy was placed in the right femoral artery and the HAI chemotherapy was carried out. In January 2006, he had swellings of the right lower leg and inguinal region and was admitted to our hospital for a hematoma in the site of the reservoir port and deep venous thrombosis. The swelling of the right lower leg went down with a bed rest in a couple of days. However, the hematoma of the reservoir port site was increased. The hematoma was removed and sutured to stop bleeding and then compression homeostasis was applied for a week. An enhanced pelvic CT scan showed a pseudoaneurysm in the femoral artery and an impending rupture was suspected. He was immediately referred to a vascular surgeon and underwent emergency surgery. Intraoperative angiography showed a pseudoaneurysm, 2.5 cm in diameter, in the femoral artery. An approximate 1 cm tear around the catheter insertion site was found and a primary suture was performed. A rapid diagnosis and treatment are required when a pseudoaneurysm is suspected during HAI chemotherapy.     

Biopsy sampling of breast lesions: comparison of core needle- and vacuum-assisted breast biopsies

Needle biopsy is now the initial investigation of choice for the pre-operative diagnosis of breast lesions. This includes core needle biopsy (CNB) and vacuum-assisted biopsy (VAB) with or without radiologic assistance. The performance indices of both of these biopsy techniques were evaluated. In a large cohort of patients with breast lesions including 464 cases (285 CNB and 179 VAB), with confirmed outcomes, the diagnostic accuracy was compared using parameters including quantitation of the sampling based on the total number of cores taken, cores containing breast parenchyma, and cores with lesion; and non-epithelial changes including necrosis and calcification. CNB showed a 99% PPV, 94% NPV, 96% sensitivity, and 99% specificity, whereas VAB demonstrated a 100% PPV, 100% NPV, 100% sensitivity, and 100% specificity. The correct diagnosis in CNB was proportional to the number of cores extracted, whereas accuracy of VAB was independent of the total number of cores taken. There was a positive correlation between the presence of calcification and malignancy in CNB, but not detected under VAB. CNB and VAB were equally efficient in palpable lesions, in detecting necrosis, and calcification. Large calcification was found to be associated with malignancy in both CNB and VAB. In non-palpable lesions, VAB was more effective in the detection of calcification. The diagnostic accuracy of VAB appeared to be independent of number of cores sampled, whereas CNB required a minimum of 3–4 cores to achieve high diagnostic accuracy.