Humans ; Female ; Diagnosis, Differential ; Breast/pathology* ; Carcinoma, Intraductal, Noninfiltrating/pathology* ; Breast Neoplasms/pathology*

PURPOSE: This study assessed the outcomes of ultrasound (US)-guided core needle biopsies (CNBs) of breast lesions with at least 2 years of follow-up to determine the false-negative rate and to evaluate the diagnostic accuracy of CNB. METHODS: We retrospectively analyzed 13,254 consecutive US-guided 14-gauge CNBs for breast lesions. We excluded biopsies if non-malignant biopsy result was not confirmed by surgical excision or US-guided vacuum-assisted biopsy, or fewer than 2 years of follow-up data were available. A total of 4,186 biopsies were excluded, and 9,068 breast masses from 7,039 women were included. The pathologic findings from each CNB were assessed using the standard diagnostic reference, defined based on the results of surgical excision, vacuum-assisted biopsy, or at least 2 years of long-term imaging follow-up. The false-negative rate and underestimation rate were calculated. RESULTS: Of the 9,068 CNBs, benign pathology was found in 64.2%, high-risk results in 3.5%, and malignant results in 32.3%. Of the 5,821 benign CNBs, an additional malignancy was found at excision in 63 lesions, leading to a false-negative rate of 2.0% (63 of 3,067). The underestimation rate was 33.6% (111 of 330) for ductal carcinoma in situ and 24.5% (79 of 322) for high-risk results at surgical excision. Most false-negative diagnoses (84.1%, 53 of 63) were recognized through imaging-histology correlations, and immediate rebiopsies were performed. Ten malignancies (15.9%, 10 of 63) had delayed diagnoses and showed progression in follow-up US imaging. CONCLUSION: US-guided 14-gauge CNB provided optimal diagnostic information. Imaging-histology correlations and appropriate imaging follow-up should be performed to avoid delayed diagnoses.
Biopsy* ; Biopsy, Large-Core Needle ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Delayed Diagnosis ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Image-Guided Biopsy ; Pathology ; Retrospective Studies ; Ultrasonography

PURPOSE: Stereotactic vacuum-assisted breast biopsy (VAB) has been established as a standard method for histological diagnosis of microcalcification or nonpalpable breast lesions on mammography. Generally, the procedure has been done under the prone position or upright sitting position. We herein attempt to evaluate clinical utility of Stereotactic VAB under lateral decubitus position. METHODS: One hundred six women (mean age, 51.2 years) with mammographically detected microcalcification underwent lateral decubitus positioning VAB using the 8G probe. In all cases, we obtained mammography specimens for identification of microcalcification and postprocedure mammography. We reviewed mean procedure time, pieces of specimen, pathology and follow-up mammography. RESULTS: The procedure took approximately 20 minutes (range, 15-24 minutes). Average number of obtained specimens was 8.5 pieces (range, 6-12 pieces). Microcalcifications were confirmed in both specimen mammography and microscopic slides. Of 106 cases, 10 cases were diagnosed as ductal carcinoma in situ. Additional surgical management was performed. Atypical ductal hyperplasias were found in 8 cases, and fibrocystic changes in 88 cases. CONCLUSION: Stereotactic VAB using the 8G probe under lateral decubitus position does not need a dedicated table, and is easier to maintain the position. Also, this procedure is accurate and safe. Thus, stereotactic VAB using the 8G probe under lateral decubitus position will be a useful method for diagnosis of microcalcification or nonpalpable breast lesions on mammography.
Biopsy* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hyperplasia ; Mammography ; Pathology ; Prone Position ; Stereotaxic Techniques

PURPOSE: To identify predictive factors of upstaging from diagnosed ductal carcinoma in situ (DCIS) to invasive cancer after surgical excision. METHODS: One hundred seventy-four patients diagnosed with DCIS based on biopsies between January 2009 and December 2014 were evaluated. Patients' clinicopathological variables were assessed to identify predictive factors of invasive carcinoma from final pathology. RESULTS: One hundred seventy-four cases of DCIS were included. Of these, 42 were upstaged to invasive carcinoma on the final excision. Preoperative features such as age 40 years or younger at diagnosis, presence of a palpable mass, ultrasonography (USG)-guided core needle biopsy, tumor size ≥20 mm on USG, high grade DCIS, cribriform DCIS, comedo necrosis, presence of intraluminal calcification, estrogen receptor negativity, progesterone receptor negativity and triple-negative subtype were significantly associated with the risk of invasive carcinoma. Multivariate analysis showed that a tumor size ≥20 mm on USG and triple negative subtype were independently associated with upstaging. CONCLUSION: Tumor size ≥20 mm on USG and triple-negative subtype were independently associated with the upstaging of DCIS to invasive cancer.
Biopsy ; Biopsy, Large-Core Needle ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Diagnosis ; Estrogens ; Humans ; Multivariate Analysis ; Necrosis ; Pathology ; Receptors, Progesterone ; Ultrasonography

OBJECTIVETo investigate the expression of high-molecular-weight keratins CK5/6, CK14, estrogen receptor (ER) and progesterone receptor (PR) in differential diagnosis of simple ductal hyperplasia (UDH), atypical ductal hyperplasia (ADH) and low-grade ductal carcinoma in situ (low-grade DCIS) .

METHODSThe clinicopathological data of twenty cases of atypical ductal epithelial hyperplasia (ADH) with focal cancerization changed into low-grade DCIS diagnosed at Tianjin Medical University Cancer Institute and Hospital between January 2013 and February 2014 were reviewed and analyzed. The expressions of CK5/6, CK14, ER and PR were detected by immunohistochemistry.

RESULTSPositive expressions of CK5/6 and CK14 were seen in UDH showing a mosaic pattern, while negative expression in ADH and low-grade DCIS. In addition, CK5/6 and CK14 were positively expressed in the myoepithelial cells of UDH, ADH and low-grade DCIS. Positive expressions of ER and PR were observed in UDH, ADH and low-grade DCIS. But they presented diffuse and homogeneous strong positive expression in ADH and variable positive expression in UDH.

CONCLUSIONIn the intraductal proliferative lesions of the breast, the use of combined detection of the expression of CK5/6, CK14, ER and PR is of practical significance in the differential diagnosis of UDH, ADH and low-grade DCIS.

Breast ; metabolism ; pathology ; Breast Neoplasms ; diagnosis ; metabolism ; Carcinoma, Ductal, Breast ; diagnosis ; metabolism ; Carcinoma, Intraductal, Noninfiltrating ; diagnosis ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Hyperplasia ; diagnosis ; metabolism ; Immunohistochemistry ; Keratin-14 ; metabolism ; Keratin-5 ; metabolism ; Keratin-6 ; metabolism ; Receptors, Estrogen ; metabolism ; Receptors, Progesterone ; metabolism

Carcinoma, Intraductal, Noninfiltrating ; diagnosis ; pathology ; surgery ; Carcinoma, Pancreatic Ductal ; pathology ; Diagnosis, Differential ; Humans ; Male ; Prostate ; pathology ; Prostatic Intraepithelial Neoplasia ; pathology ; Prostatic Neoplasms ; diagnosis ; pathology ; surgery

Biopsy, Needle ; Breast ; pathology ; Breast Neoplasms ; classification ; metabolism ; pathology ; Carcinoma, Ductal, Breast ; metabolism ; pathology ; Carcinoma, Intraductal, Noninfiltrating ; metabolism ; pathology ; Carcinoma, Papillary ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Humans ; Hyperplasia ; Keratin-14 ; metabolism ; Keratin-5 ; metabolism ; Keratin-6 ; metabolism ; Membrane Proteins ; metabolism ; Papilloma, Intraductal ; metabolism ; pathology ; Receptors, Estrogen ; metabolism

BACKGROUNDIodine staining during endoscopy has been successfully used to detect early carcinomatous and precancerous lesions in the esophagus, cervix, and oral cavity. The objective of this study was to determine the diagnostic accuracy of fiberoptic ductoscopy (FDS) plus in vivo iodine staining for intraductal proliferative lesions of the breast.

METHODSWe performed periodic acid-Schiff (PAS) and in vitro iodine staining on 52 and 64 specimens of benign mammary hyperplasia, respectively, and 57 and 53 specimens of ductal carcinoma in situ (DCIS), respectively. Next, FDS was performed on 177 recurrent nipple discharge patients who were randomly divided into two groups. One group was iodine-staining group in which 92 patients were randomly selected to undergo iodine staining during FDS, and the remaining 85 were assigned to the control group. Biopsy specimens of suspicious lesions were obtained and subjected to histopathological examination.

RESULTSFollowing PAS staining, benign mammary hyperplasia lesions were positively stained, while negligible PAS positivity was observed in the DCIS lesions (P < 0.05). Following in vitro iodine staining, benign mammary hyperplasia specimens appeared dark brown, whereas DCIS samples appeared significantly lighter or unstained. Compared with the pathological examination results, FDS with iodine staining showed an agreement rate in the diagnosis of ductal intraepithelial neoplasia (DIN), sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and Youden index of 97.82%, 98.83%, 83.33%, 5.93, 0.014, and 0.8216, respectively; the corresponding values for FDS without iodine staining were 88.24%, 89.16%, 50.00%, 1.78, 0.217, and 0.3916, respectively.

CONCLUSIONFDS with iodine staining was superior to conventional FDS for the diagnosis of DIN and is valuable for breast cancer prevention.

Adult ; Aged ; Breast ; pathology ; Breast Neoplasms ; diagnosis ; pathology ; Carcinoma, Ductal, Breast ; diagnosis ; pathology ; Carcinoma, Intraductal, Noninfiltrating ; diagnosis ; pathology ; Female ; Fiber Optic Technology ; Humans ; Hyperplasia ; Iodine ; Middle Aged ; Periodic Acid-Schiff Reaction ; Staining and Labeling

Breast ; pathology ; Carcinoma, Intraductal, Noninfiltrating ; diagnosis ; metabolism ; pathology ; Female ; Humans ; Hyperplasia ; metabolism ; pathology ; Keratin-5 ; metabolism ; Keratin-6 ; metabolism ; Precancerous Conditions ; diagnosis ; metabolism ; pathology ; Stem Cells ; metabolism ; pathology

OBJECTIVETo compare the efficacy of methylene blue versus carbon nanopartIcles suspension injection as a tracer for sentinel lymph node detection in breast cancer and the factors associated with the definition of sentinel lymph node biopsy.

METHODSOne hundred and sixteen patients with early breast cancer underwent intraoperative sentinel lymph node biopsy, among them 51 patients accepted injection of methylene blue dye, while 65 patients received carbon nanopartIcles suspension injection. The mapping procedures and SLNB were performed using subareolar or peritumoral injection of methylene blue or carbon nanopartIcles suspension injection at the site of the primary breast cancer, followed by the axi11ary lymph node dissection (ALND). All the SLN and ALN were evaluated pathologically post-operatively.

RESULTSIn the MB group, the false-negative, sensitivity, accuracy, specificity rate of SLNB detection were 88.2%, 13.3%, 86.7%, 84.3%, and 100%, respectively. In the CNP group, the false-negative, sensitivity, accuracy, specificity rate of SLNB detection were 98.5%, 8.7%, 91.3%, 95.4%, and 100%, respectively. The false-negative, sensitivity, specificity rate in the CNP group were trended to be higher than those in the MB group, but the difference of the accuracy and detection rates are significant (P < 0.05).

CONCLUSIONSCompared with methylene blue solution, the carbon nanoparticle injection shows a better stability and operability for the sentinel lymph node detection in breast cancers.

Adult ; Aged ; Axilla ; Breast Neoplasms ; pathology ; surgery ; Carbon ; Carcinoma, Ductal, Breast ; pathology ; surgery ; Carcinoma, Intraductal, Noninfiltrating ; pathology ; surgery ; Carcinoma, Lobular ; pathology ; surgery ; False Negative Reactions ; Female ; Humans ; Injections ; methods ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; diagnosis ; Methylene Blue ; Middle Aged ; Nanoparticles ; Neoplasm Staging ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy ; methods