Breast fine‐needle aspiration samples reported as “proliferative breast lesion”: Clinical utility of the subcategory “proliferative breast lesion with atypia”

BACKGROUND:

The fine‐needle aspiration (FNA) diagnosis of proliferative breast lesion is an indeterminate category. The aim of this correlative study was to determine whether a subcategory of “proliferative breast lesion with atypia” was achievable and whether this subcategory has management utility.

METHODS:

Breast FNA cases from 2000 through 2005 diagnosed as proliferative breast lesion and proliferative breast lesion with atypia were retrieved. Both cytologic and surgical slides of these cases were reviewed blindly. A cytologic diagnosis of proliferative breast lesion (without atypia) or proliferative breast lesion with atypia was used if the findings of the proliferative breast lesion did not fit a more specific category.

RESULTS:

Of the 3934 breast FNAs performed on palpable breast masses from January 2000 to December 2005 at the LAC + USC Medical Center, 317 (8.1%) were diagnosed cytologically as proliferative breast lesion with atypia, without atypia or without mention of atypia. There was subsequent histopathology on 201 of these cases. After the cytologic smears were reviewed, 29 cases were excluded from this study. Of the 172 remaining cases, 21 (12.2%) were found to be malignant and the remaining 151 (87.8%) were found to be benign on histology. Of the malignant cases, 90% had an FNA diagnosis of proliferative breast lesion with atypia; of the benign cases, 78% were interpreted as proliferative breast lesion without atypia.

CONCLUSIONS:

Proliferative breast lesion with atypia was clinically significant because it was associated with a significantly increased likelihood of malignancy compared with proliferative breast lesion without atypia. Most of the malignancies had hypocellularity or low nuclear grade on the FNA smears. Fibroadenoma accounted for most of the benign lesions in both proliferative breast lesion and proliferative breast lesion with atypia. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.     

Papanicolaou test interpretations of “atypical squamous cells,cannot exclude high‐grade squamous intraepithelial lesion”

BACKGROUND.

Management guidelines for women with Papanicolaou (Pap) test interpretations of ASC‐H (atypical squamous cells, cannot exclude high‐grade squamous intraepithelial lesion) reflect substantial risk, which ranges from 10% to 68%, of a cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in their follow‐up histologic samples. The present study was initiated to determine the number of colposcopic procedures and the time frame that are typically required for a definitive diagnosis of a CIN2+ lesion after a Papanicolaou (Pap) test interpretation of ASC‐H in routine practice.

METHODS.

Clinicopathologic data on consecutive ASC‐H interpretations, 97% of which were on liquid‐based preparations, were reviewed. The number of biopsies (which was used in this context as a surrogate indicator for the number of colposcopic procedures) as well as the average duration required for a follow‐up histologic diagnosis of CIN2+ were determined.

RESULTS.

Of 500 ASC‐H interpretations, 75 were excluded for a variety of reasons and 165 lacked follow‐up in our records. The average age and follow‐up duration for the remaining 260 patients was 35.6 years and 18.5 months, respectively. CIN2+ was diagnosed in 49 (40%) of the 122 patients with at least 1 histologic follow‐up. Of these 49 patients, 72% (35 of 49) were diagnosed on the first follow‐up cervical biopsy, 14% (7 of 49) and 8% (4 of 49) were diagnosed on the second and third follow‐up biopsies, respectively; in only 6% (3 of 49) was a fourth follow‐up biopsy required. Overall, an average of 1.53 biopsies (range, 1–4) was required to attain a definitive diagnosis of CIN2+, and 28% of patients required more than 1 follow‐up biopsy. The average period between the index ASC‐H interpretations and CIN2+ diagnoses was 5.5 months. The average time to CIN2+ diagnoses by the first follow‐up biopsy was 3 months; for diagnoses made on subsequent biopsies, the average additional follow‐up duration was 8 months. Of the eventual CIN2+ diagnoses, 84% were rendered within 12 months of their associated index ASC‐H interpretations.

CONCLUSIONS.

1) A substantial subset—28%—of patients with biopsy‐proven CIN2+ after ASC‐H interpretations required more than 1 colposcopy for a definitive diagnosis of a high‐grade dysplastic lesion. 2) If a CIN2+ lesion is present, the vast majority can be diagnosed in a biopsy performed within 1 year of the ASC‐H interpretation. Cancer (Cancer Cytopathol) 2007. © Published 2007 by the American Cancer Society.     

Adjuvant chemotherapy for the “oldest old” ovarian cancer patients

BACKGROUND:

Patients aged ≥80 years who are diagnosed with advanced ovarian cancer (OC) have been reported to have a poor prognosis. In the current study, chemotherapy?related toxicity data were evaluated between patients aged ≥80 years and those aged <80 years.

METHODS:

Patients with OC who underwent cytoreductive surgery with chemotherapy were included. Self‐reported toxicity data were obtained from National Cancer Institute Common Toxicity Criteria (CTC) forms. Objective indicators of status including albumin level, weight, and creatinine clearance were abstracted both before and after therapy. Data were compared between patients by decade of age.

RESULTS:

A total of 246 patients were included. A presenting Karnofsky performance status >2 was recorded in 17% of patients aged ≥80 years versus 0% to 4% of patients aged <80 years (P = .002). Platinum‐based chemotherapy was used in all patients. For patients aged <80 years, combination chemotherapy was used in >90% versus 69% in those aged ≥80 years (P < .0001). Standard?dose combination therapy was used in 72% to 86% of patients aged <80 years versus 28% of patients aged ≥80 years (P < .0001). Patients aged ≥80 years completed ≥6 cycles of therapy approximately 57% of the time versus 84% to 97% of the time for those aged <80 years (P = .0001). CTC forms identified no self‐reported toxicities to be more common among patients aged ≥80 years. Multivariate logistic regression identified creatinine clearance <65 mL/minute (odds ratio [OR] of 4.6), 5% weight loss (OR of 2.5), prechemotherapy albumin level of <2 g/dL (OR of 3.65), and initiation of therapy with a single agent (OR of 3.9) as independent predictors of failure to complete chemotherapy.

CONCLUSIONS:

Despite initial treatment modifications as well as toxicity assessment, only 57% of patients aged ≥80 years completed planned chemotherapy. It was confirmed that further studies into the pharmacokinetics of chemotherapy in the elderly and more sensitive assessment of therapy?related toxicity are required. Cancer 2009. © 2009 American Cancer Society.