Search

Purpose: Tumour-stroma ratio (TSR) is an important prognostic and predictive factor in several tumour types. The aim of this study is to determine whether TSR evaluated in breast cancer core biopsies is representative of the whole tumour. Method: Different TSR scoring methods, their reproducibility, and the association of TSR with clinicopathological characteristics were investigated in 178 breast carcinoma core biopsies and corresponding resection specimens. TSR was assessed by two trained scientists on the most representative H&E-stained digitised slides. Patients were treated primarily with surgery between 2010 and 2021 at Semmelweis University, Budapest. Results: Ninety-one percent of the tumours were hormone receptor (HR)-positive (luminal-like). Interobserver agreement was highest using 100 × magnification (κcore = 0.906, κresection specimen = 0.882). The agreement between TSR of core biopsies and resection specimens of the same patients was moderate (κ = 0.514). Differences between the two types of samples were most frequent in cases with TSR scores close to the 50% cut-off point. TSR was strongly correlated with age at diagnosis, pT category, histological type, histological grade, and surrogate molecular subtype. A tendency was identified for more recurrences among stroma-high (SH) tumours (p = 0.07). Significant correlation was detected between the TSR and tumour recurrence in grade 1 HR-positive breast cancer cases (p = 0.03). Conclusions: TSR is easy to determine and reproducible on both core biopsies and in resection specimens and is associated with several clinicopathological characteristics of breast cancer. TSR scored on core biopsies is moderately representative for the whole tumour. [ABSTRACT FROM AUTHOR]

No study has validated, compared and adapted scoring systems for prognosis prediction based on donor kidney core biopsy (CB), with less glomeruli than wedge biopsy. A total of 185 donor kidney CB specimens were reviewed using seven scoring systems. The association between the total score, item scores, score-based grading, and allograft prognosis was investigated. In specimens with less than ten glomeruli (88/185, 47.6%), scoring systems were modified by adjusting weights of the item scores. The Maryland aggregate pathology index (MAPI) score-based grading and periglomerular fibrosis (PGF) associated with delayed graft function (DGF) (Grade: OR = 1.59, p < 0.001; PGF: OR = 1.06, p = 0.006). Total score, score-based grading and chronic lesion score in scoring systems associated with one-year and 3-year eGFR after transplantation. Total-score-based models had similar predictive capacities for eGFR in all scoring systems, except MAPI and Ugarte. Score of glomerulosclerosis (GS), interstitial fibrosis (IF), tubular atrophy (TA), and arteriolar hyalinosis (AH) had good eGFR predictive capacities. In specimens with less than ten glomeruli, modified scoring systems had better eGFR predictive capacities than original scoring systems. Scoring systems could predict allograft prognosis in paraffin-embedded CB with ten more glomeruli. A simple and pragmatic scoring system should include GS, IF, TA and AH, with weights assigned based on predictive capacity for prognosis. Replacing GS scores with tubulointerstitial scores could significantly improve the predictive capacity of eGFR. The conclusion should be further validated in frozen section. [ABSTRACT FROM AUTHOR]

Background No study has validated, compared and adapted scoring systems for prognosis prediction based on donor kidney core biopsy (CB), with less glomeruli than wedge biopsy.Methods A total of 185 donor kidney CB specimens were reviewed using seven scoring systems. The association between the total score, item scores, score-based grading, and allograft prognosis was investigated. In specimens with less than ten glomeruli (88/185, 47.6%), scoring systems were modified by adjusting weights of the item scores.Results The Maryland aggregate pathology index (MAPI) score-based grading and periglomerular fibrosis (PGF) associated with delayed graft function (DGF) (Grade: OR = 1.59, p

Diabetic mastopathy is a rare fibro-inflammatory breast disease that closely mimics breast carcinoma. The disease predominantly affects insulin-dependent diabetics, and the etiology is still unclear. A proper physical examination, imaging, and core-needle biopsy usually lead to a diagnosis. Management is conservative and revolves around counseling the patient to allay fears and regular follow-up. In this review, we highlight the recent information on diabetic mastopathy with emphasis on historical background, epidemiology, etiopathogenesis, diagnostic approaches, and treatment choices.

Background. Core biopsy of the breast is currently considered to be the standard method of obtaining material for morphological and molecular genetic methods. Unfortunately, this method is associated with a number of problems, primarily the risk of complications (bleeding, pneumothorax) and discomfort during manipulation.Aim. To analyze transcriptional signatures of breast tissue samples obtained by fine-needle aspiration biopsy. Materials and methods. Using reverse transcriptase polymerase chain reaction, we studied the mRNA expression level of 60 target genes in 60 samples obtained by fine-needle aspiration biopsy and in 60 corresponding formalin-fixed paraffin-embedded (FFPE) surgical specimens of breast. Samples were obtained from the tumor, adjacent tissue, the so-called tumor bed and formally normal tissue at a distance from the primary lesion.Results. A comparative analysis of transcriptional signatures in samples obtained by fine-needle aspiration biopsy and FFPE specimens (120 samples in total) reveled the strongest correlations between transcriptional signatures in biopsy samples and FFPE specimens of tumors. Very strong correlation in tumor samples was established for one gene (CTSL2); strong for 18 genes (MKI67, MYBL2, NAT1, PTEN, TPX2, PTTG1, UBE2T, CCNB1, ESR1, CCND1, MYC, SCGB2A2, MIA, TRAC, FGFR4, ANLN, GSTM1, PRLR); averages for 28 genes (PGR, AURCA, KRT5, FOXA1, SFRP1, EMSY, EXO1, PAK1, KIF14, ERBB2, MMP11, BCL2, BAG1, TMEM45B, BIRC5, CD274/PDL1, ZNF703, TYMS, CCNE1, TPT1, TMEM45A, BRCA1, BRCA2, ESR2, STS, TNFSF11/RANKL, TNFRSF11B/OPG, TNF); weak for 4 genes (GRB7, EGFR, PGRMC1, CYP19A). The presence of correlations between transcriptional signatures in biopsy samples and FFPE specimens can be established in case of sufficient material corresponding to sample intake control (SIC) ≥5 lg for B2M gene.Conclusion. The ability to conduct molecular genetic research on small samples of breast tissue makes it possible to obtain the material using the most minimally invasive method. And this, in turn, expands the possibilities of “genetic monitoring” of cancer, as well as the possibility of more accurate assessment the risks of malignant tumor development in the settings of benign conditions in women with fibrocystic disease and increased mammographic density.

Diabetic mastopathy is a rare fibro-inflammatory breast disease that closely mimics breast carcinoma. The disease predominantly affects insulin-dependent diabetics, and the etiology is still unclear. A proper physical examination, imaging, and core-needle biopsy usually lead to a diagnosis. Management is conservative and revolves around counseling the patient to allay fears and regular follow-up. In this review, we highlight the recent information on diabetic mastopathy with emphasis on historical background, epidemiology, etiopathogenesis, diagnostic approaches, and treatment choices. [ABSTRACT FROM AUTHOR]

Eight patients with apical lobe lung lesions referred for image-guided biopsy where the lesion was abutting the mediastinal or apical pleura, and was visible in ultrasound using a suprasternal–supraclavicular route were consented and subjected to successful ultrasound-guided transcervical biopsy using different routes based on lesion characteristics and location of vital vascular structures—either through the thyroid gland, by the side of the gland lateral to the common carotid artery, or between the thyroid gland and common carotid artery after hydrodissection. Transthyroid access was used in 50% of cases. There were no immediate or long-term complications in any patient over a mean follow-up period of 28.5 months. Sample adequacy was 100%.

Eight patients with apical lobe lung lesions referred for image-guided biopsy where the lesion was abutting the mediastinal or apical pleura, and was visible in ultrasound using a suprasternal–supraclavicular route were consented and subjected to successful ultrasound-guided transcervical biopsy using different routes based on lesion characteristics and location of vital vascular structures—either through the thyroid gland, by the side of the gland lateral to the common carotid artery, or between the thyroid gland and common carotid artery after hydrodissection. Transthyroid access was used in 50% of cases. There were no immediate or long-term complications in any patient over a mean follow-up period of 28.5 months. Sample adequacy was 100%. [ABSTRACT FROM AUTHOR]

The frequency of detection of renal masses has increased over recent decades, causing a concurrent increase in early intervention by surgery. Growing recognition that this approach was contributing to overtreatment led to the broader use of preoperative renal mass biopsy (RMB) by core biopsy and/or fine‐needle aspiration. Because more options for management, such as active surveillance and personalized therapy, are becoming increasingly available, a diagnosis by RMB is becoming a valuable tool for risk stratification and clinical decision making. Guidelines from various professional organizations have outlined situations in which RMB should be used, and it has been shown to be safe and effective. Rapid on‐site evaluation (ROSE) using touch preparations of core biopsy or fine‐needle aspiration smears provides an immediate assessment of adequacy and appropriate triage. ROSE also ensures sufficient material to perform immunohistochemistry and molecular studies for more accurate characterization of renal masses and personalized treatment. The integral role of cytopathology laboratories in precision medicine can also be successfully used in optimizing the workup of RMB from ROSE to final diagnosis, prognostication, and personalized management of kidney tumors. Herein, the authors review their extensive experience working together with interventional radiology and urology colleagues to use core biopsy and ROSE at the time of RMB for diagnosis and management of these lesions. There is greater recognition for the role of renal mass biopsy (RMB) in guiding patient management and, although practices vary between institutions, the overall use of RMB is increasing in the current era of precision management. Cytopathology laboratories play an important role in optimizing the workup of RMB from rapid on‐site evaluation to final diagnosis. Herein, the authors review the existing literature and share their experience from a large, academic tertiary care center. [ABSTRACT FROM AUTHOR]

Background/aim A crucial approach for finding breast cancer sooner is the triple examination of breast diseases. Our goal was to determine if ultrasound-guided core biopsies were required to investigate clinically ambiguous breast tumors that lacked imaging features suspicious for malignancy in Breast Imaging Reporting and Data System 3. Patients and methods A prospective study was performed on 50 patients fulfilling our eligibility criteria who presented with symptomatic indeterminate breast masses chosen according to our selection criteria and underwent an ultrasonography-guided core biopsy in the period from January 2021 to March 2022. Results A total of 50 clinically ambiguous breast masses were investigated, of which 47 (94%) were benign lesions, including 34 (68%) lesions were fibroadenomas, six (12%) lesions were fibrocystic disorder without ductal hyperplasia, one (2%) lesion was fibrocystic disease with ductal hyperplasia with no atypia, and six (12%) lesions showed periductal mastitis. Two (4%) lesions were proliferative breast lesions with focal atypia. One (2%) lesion was infiltrating duct carcinoma grade 2. Conclusion Ultrasound-guided core biopsy is necessary for investigating clinically indeterminate breast mass in symptomatic patients with Breast Imaging Reporting and Data System 3 finding on imaging, for early detection of malignancy and atypical hyperplastic changes.

Background. Achieving a pathologic complete response (pCR) after neoadjuvant systemic therapy (NST) is a predictive factor for improving disease free and overall survival. In triple negative (TN) and HER2-positive breast cancer (BC), the pCR rate exceeds 60 %. Patients with TN and HER2-positive BC who demonstrate an excellent response to NST are like­ly ideal candidates for downsizing surgery. The condition for reducing the volume of surgical intervention is a reliable determination of pathologic complete response using instrumental imaging and biopsy methods.Aim. To further assess the accuracy of post-NST image-guided biopsy to predict pCR.Materials and methods. Sixty one patients with T1-3N0-3 triple negative or HER2-positive BC receiving NST in the Department of Breast Tumors of the NMRC of Oncology named after N.N. Petrov in the period from 2017 to 2019 were enrolled in this single-center retrospective trial. Patients underwent ultrasound-guided core-biopsy of the initial breast tumor region before surgery. Findings were compared with findings on pathologic evaluation of surgical specimens to determine the performance of biopsy in predicting pCR after NST.Results. After neoadjuvant systemic therapy, clinical partial response (cPR) was diagnosed in 47 (77 %) patients, clinical complete response (cCR) in 14 (23 %) patients. pCR in the core-biopsy tissue and surgical material was achieved in 46 (75.4 %) and 37 (60.7 %), respectively. Performance of image-guided core-biopsy: sensitivity 100 % (95 % confldence interval (CI) 90.51-100), specificity 62.5 % (95 % CI 40.59-81.20), false-negative rate (FNR) 0 %, positive-pre­dictive value (PPV) 75.00 % (95 % CI 59.46-85.99), negative predictive value (NPV) 100.00 %.Conclusion. This retrospective trial showed that ultrasound-guided core biopsies are accurate enough to identify breast pCR in patients with triple-negative or HER2-positive BC with good response after NST (FNR 0 %). Based on these results, a prospective clinical trial has commenced in which breast surgery is omitted in patients with a breast pCR after NST according to image-guided biopsy.

Introduction:Neoadjuvant chemotherapy (NAC) is used with increasing frequency in breast cancers. Various clinicopathological parameters predict treatment response (TR). Tumor budding (TB), which is a prognostic parameter in many cancers, can be considered the first stage of the metastatic process. In our study, the relationship between TR and clinicopathological parameters and TB in core biopsy samples of patients before NAC was investigated.Methods:Seventy-four patients were included in our study. The association between the patients’ TR and clinicopathological parameters such as estrogen (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki67, molecular subtype, axilla metastasis was examined. All core biopsy specimens of the cases were evaluated, subsequently the area with the highest intratumoral budding (ITB) was determined, and finally ITB was counted in one area in a 20x objective. Cut-off was determined according to receiver operating characteristic analysis and cases were grouped as 0.05). ITB correlated significantly with ER, PR positivity and luminal group molecular subtype (p

BACKGROUND: Pseudoangiomatous stromal hyperplasia is a rare benign breast stromal proliferative lesion of the breast. Clinical presentation ranges from rapidly growing mass to incidental identification in routine screening. This difference in manifestation and its rarity makes it difficult to be a standard treatment protocol. Therefore, we aimed to share our clinical experience in Pseudoangiomatous stromal hyperplasia. METHODS: The files of patients who underwent core biopsy or surgical excision due to a breast mass and resulted in pseudoangiomatous stromal hyperplasia between January 2013 and December 2021 were included in the study. RESULTS: 17 patients with a median age of 37 (22–68) were found Pseudoangiomatous stromal hyperplasia confirmed by surgical excision or core biopsy. Chosen treatment option was observation in 8 patients (47.1%), while surgical excision was used in 9 (52.9%) patients. The mean follow-up period was 55.24 ± 26.72 (13–102) months. None of the patients observed the Malignant transformation during the follow-up period. CONCLUSION: For Pseudoangiomatous Stromal Hyperplasia of the breast, surgical excision with clean margins or close follow-up after diagnosis confirmation by tissue biopsy is sufficient. Pseudoangiomatous Stromal Hyperplasia is not a risk factor for developing breast cancer. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to analyse the usefulness of core biopsy in the diagnosis of malignant neoplasms of the pancreas – sensitivity and accuracy of diagnosis, safety of the procedure, indication of factors that may increase the risk of complications after biopsy. Material and methods: A retrospective analysis of data was performed in a group of 100 patients diagnosed with a focal lesion of the pancreas, qualified for a core biopsy. Results: The results are a sensitivity of 92%, a specificity of 100%, and an accuracy of 93.3%. The incidence of more severe complications according to the Clavien-Dindo classification was 1% (one case in the material studied). The results of the analysis were compared with the results of other authors, showing similar values for the sensitivity and specificity of the method and low rates of serious complications; it also seems that the tissue material obtained by core biopsy has higher diagnostic potential than that obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), currently considered the method of choice. In addition, the costs of transabdominal biopsy and endoscopic biopsy were compared; the lower cost of the former may be an important economic issue when choosing the biopsy method. Conclusions: The results show core biopsy to be a sensitive, accurate, and safe method for obtaining the tissue necessary to plan treatment in patients with pancreatic cancer. [ABSTRACT FROM AUTHOR]

The presence of stromal osteoclast-like giant cells is a distinctive feature of some rare breast tumors, accounting for less than 1% of all breast cancer cases. Although the presence of stromal osteoclast-like giant cells may be encountered in different breast tumors, some authors still describe them as a specific tumor type. Usually, a histological diagnosis of breast carcinoma is made by a pathologist through a biopsy, which is then confirmed through a surgical specimen: it is rare for the two to differ, particularly when there are pathognomonic morphological markers, such as osteoclast-like giant cells. Herein, we report a case of a 45-year-old pre-menopausal woman, who was found to have a single solid mass in her right breast on screening mammogram. She underwent a core biopsy, which showed a malignant epithelial lesion arranged in tubules, glands, and papillae, intermingled with numerous stromal osteoclast-like giant cells. Therefore, a diagnosis of breast cancer with osteoclast-like giant cells was rendered. Curiously, these cells were no longer detectable in the surgical specimen. [ABSTRACT FROM AUTHOR]

Aim to determine the effectiveness of Endolaryngeal Core Biopsy and Fine Needle aspiration Cytology in endophytic or submucosal laryngeal malignancies. Background: Endophytic and submucosal laryngeal tumours pose as diagnostic as well as management challenges to the head and neck surgeon. Identifying the tumour location and extent of disease is crucial for the surgeon to determine the treatment options and the potential outcomes. Persistent laryngeal edema following radiotherapy also presents with a diagnostic dilemma, as distinguishing between recurrent laryngeal carcinoma and radiotherapy sequels; which include fibrosis, oedema and soft tissue and cartilage necrosis, can be confusing and punch biopsies performed in such cases would more than often yield inadequate or superficial tissue. Using a core biopsy gun for acquiring biopsy specimen is known to have more cellular material, less damage to the surrounding structure depth control, immediate analysis with higher accuracy rates. Technique: Patients with suspected laryngeal malignancy are initially evaluated with flexible endoscopy with Narrow band imaging (NBI) and appropriate imaging. These patients are subjected to Microlaryngoscopic under general anaesthesia. A core biopsy gun is used to obtain samples from the suspicious area. Simultaneously, with the aid of microlaryngeal forceps, an FNAC is also done and sent for rapid processing. Conclusion: Trucut biopsy is a novel diagnostic tool that can be commonly used in early laryngeal malignancies especially in those cases where there is strong suspicion of malignancy and the lesion is found to be submucosal. Clinical significance: we noted that a routine DL scopy and Biopsy in submucoal disease often results in a acquiring a non-representative sample as well as causing inadvertent trauma to the surrounding mucosa. We encourage Laryngeal surgeons to routinely use Core biopsies and FNAC during routine microlaryngeal Examination for better yield, faster diagnosis and faster planning of treatment protocols. [ABSTRACT FROM AUTHOR]

Breast imaging is a prerequisite for providing high quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease in patients who present to health professionals for treatment. These patients present to doctors of different subspecialties as well as to general practitioners in our country. It is important, therefore, to provide uniform guidance to doctors in different healthcare setups of our country, urban and rural, government and private, for optimal management of breast diseases. These guidelines framed by the task group set up by the Breast Imaging Society, India, have been formulated focusing primarily on the Indian patients and health care infrastructures. They aim to provide a framework for the referring doctors and practicing radiologists to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases, so that breast cancer is not missed. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India. Part 2 of these guidelines focuses on the best practice principles for breast interventions and provides algorithms for the investigation of specific common breast symptoms and signs. Ultrasound is the preferred imaging modality for image-guided breast interventions due to real-time needle visualization, easy availability, patient comfort and absence of radiation. Stereotactic mammography guided procedures are performed if the lesion is visualized on mammography but not visualized on ultrasound. 14-gauge automated core biopsy device is preferred for breast biopsies although vacuum assisted biopsy devices are useful for biopsy of certain abnormalities as well as for imaging guided excision of some pathologies. MRI guided biopsy is reserved for suspicious lesions seen only on MRI. Algorithms for investigation of patients presenting with mastalgia, breast lumps, suspicious nipple discharge, infections and inflammation of the breast have been provided. For early breast cancers routine use of investigations to detect occult distant metastasis is not advised. Metastatic work up for advanced breast cancer is required for selection of appropriate treatment options.

Purpose: The aim of this study is to develop a pre-operative prognostic model based on known pre-operative factors. Methods: A database of ultrasound (US) lesions undergoing biopsy documented US lesion size, stiffness, and patient source prospectively. Women with invasive cancer presenting between 2010 and 2015 were the study group. Breast and axillary core results and ER, PR and HER receptor status were collected prospectively. Assessment of US skin thickening, US distal enhancement and presence of chronic kidney disease (CKD) was performed retrospectively. Patient survival and cause of death were ascertained from computer records. Predictive models for (i) all-cause mortality (ACM) and (ii) breast cancer death (BCD) were built and then validated using bootstrap k-fold cross-validation. A comparison of predictive performance was made between a full cause-specific Cox model, a sub cause-specific Cox model, and a full Fine-Gray sub-distribution hazard model. Results: 1136 patients were included in the study. The median follow-up time was 6.2 years. 125 (11%) women died from breast cancer and 155 (14%) died from other causes. For the prediction of BCD, the cause-specific Cox sub-model performed the best. The time dependent AUC begins above 0.91 in year one to 3 reducing to 0.83 in year 6. The factors included in the Cox sub model were tumour size, skin thickening, source of detection, tumour grade, ER status, pre-operative nodal metastasis and CKD. Conclusion: We have shown that a model based on preoperative factors can predict BCD. Such prediction if externally validated and incorporating treatment data could be useful for treatment planning and patient counselling.

Introduction: Imaging-guided breast tissue biopsy has become an acceptable alternative to open surgical biopsy for nonpalpable breast lesions. Discussion of abnormal results of the correlation between imaging and pathological findings can be very challenging as it can assist in decision-making with regard to the further treatment options by arriving at a comprehensive diagnosis. Materials and Methods: This was a retrospective study. Radiological data from imaging-guided breast biopsies of 500 patients during a 6-year period was collected and classified by a specialist radiologist as per the BI-RADS format. Histopathology reports were studied and discordance analyzed. Results: A total of 500 cases were reviewed. Approximately 33% (168) cases fell into the BI-RADS 3 category, 24.4% (122) into the BI-RADS 4, and 37% (187) into BI-RADS 5 categories. Approximately 50% (n = 250) cases were benign, 2.6% (13) belonged to the high-risk category, and 47.4% (237) were malignant. The number of discordant cases was 12 (2.4%), mostly due to technical factors. Sensitivity of biopsies to detect malignancy was 85%, specificity was 96%, and accuracy of biopsy in diagnosing cancer was 90%. Discussion: The "triple assessment" is the most sensitive method for detecting early breast cancer. An effective communication pathway must be established between a clinician, radiologist, and pathologist for surgical excision in discordance as it carries a high prevalence of carcinoma in these lesions. Conclusion: In discordant cases, either due to abnormal results of imaging or of abnormal pathological findings, the final decision is based on two concordant findings, out of the three parameters. This involves a multidisciplinary breast conference and an active participation by the pathologist.

Introduction: Neoadjuvant chemotherapy (NAC) is used with increasing frequency in breast cancers. Various clinicopathological parameters predict treatment response (TR). Tumor budding (TB), which is a prognostic parameter in many cancers, can be considered the first stage of the metastatic process. In our study, the relationship between TR and clinicopathological parameters and TB in core biopsy samples of patients before NAC was investigated. Methods: Seventy-four patients were included in our study. The association between the patients' TR and clinicopathological parameters such as estrogen (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki67, molecular subtype, axilla metastasis was examined. All core biopsy specimens of the cases were evaluated, subsequently the area with the highest intratumoral budding (ITB) was determined, and finally ITB was counted in one area in a 20x objective. Cut-off was determined according to receiver operating characteristic analysis and cases were grouped as <4: low budding; ≥4: high ITB. Results: High nuclear grade, ER and PR negativity, HER2 positivity, molecular groups, and absence of angiolymphatic invasion or axillary lymph node metastasis were statistically correlated with a complete response to treatment (p<0.05). ITB was not associated with TR (p>0.05). ITB correlated significantly with ER, PR positivity and luminal group molecular subtype (p<0.05). Conclusion: ER, PR negativity, HER2 positivity, high Ki67, and high nuclear grade, invasive ductal carcinoma histological subtype were associated with complete TR, whereas ITB was not associated with TR. Further studies are required to elucidate the prognostic significance of ITB in core biopsy specimens. [ABSTRACT FROM AUTHOR]

Purpose of Review: A growing number of tumor entities with badly defined limits are enlarging in the last years the family of oncocytic tumors in the kidney. Recent Findings: Chromophobe renal cell carcinoma (ChRCC) and renal oncocytoma (RO) are classically well-known tumors, but the borderland between them, and their precise connection, remains a matter of debate. Aside from that, other emerging and provisional entities, like eosinophilic solid and cystic renal cell carcinoma (ESC RCC), eosinophilic vacuolated tumor (EVT), low-grade oncocytic tumor (LOT), and papillary renal neoplasm with reverse polarity (PRRP), have been recently described. This spectrum of tumors remains a diagnostic challenge in renal pathology, especially if the specimen obtained is scarce. Summary: This review focuses on practical diagnostic problems when managing core biopsies and proposes a diagnostic algorithm maximizing the information provided by both morphology and immunohistochemistry. So, a combination of morphologic features on hematoxylin-eosin and six antibodies (CK7, CD117, CK20, CD10, GATA-3, and cathepsin K) is advised to be used in a stepwise fashion. [ABSTRACT FROM AUTHOR]

Introduction: This retrospective study aimed to determine the percentage of MRI‐detected breast cancers diagnosed using targeted ultrasound and standard 14‐gauge (14g) biopsy in the setting of an Australian breast MRI service. This is of clinical relevance because malignancies not identifiable on mammography or by ultrasound may then require more invasive, technically demanding and costly MRI‐guided interventional procedures, usually by large‐core vacuum‐assisted biopsy (VAB) or hook‐wire localisation with open surgical biopsy. Methods: On review of the 12‐year period 2006–2018, we identified 67 new breast cancer events in 64 women where the diagnosis was made on the basis of the MRI scan findings either alone (n = 60) or in combination with a concurrent mammogram (n = 7), with no recorded clinical abnormality. The percentage in which malignancy was confirmed on histopathology using targeted ultrasound in combination with 14g biopsy was determined versus other biopsy methods, for both invasive cancer and in situ disease. Results: Ultrasound‐guided 14g biopsy was successful in establishing the presence of malignancy in 42/46 (91%) of events with a final diagnosis of invasive cancer, with 2 more proven by MRI‐guided interventional procedures (1 VAB and 1 hook‐wire) and 1 by open surgical biopsy. In the final case, a 5 mm focus on MRI with no sonographic correlate at the initial presentation was only identified and biopsied by ultrasound at 12‐month follow‐up. For events with a final diagnosis of DCIS/pLCIS (pleomorphic LCIS, n = 2), US‐guided 14g biopsy was successful in 10/21 (48%), while 4/7 events with corresponding mammographic microcalcifications were proven by x‐ray stereotactic interventions. A further 5 events had MRI‐guided interventions (3 VAB and 2 hook‐wires) and 1 an open surgical biopsy to confirm malignancy. In the final case (a woman with a 30 × 20 mm focal area of non‐mass enhancement with corresponding microcalcifications consistent with DCIS), a pathologic diagnosis was not made until the patient presented 5 years later with invasive disease. There were also 3 instances of upgrades to invasion on final surgical pathology, one from pLCIS to microinvasion and 2 others from DCIS to IDC. Among the DCIS/pLCIS events, semi‐random 14g core biopsy (sampling at the expected location of the MRI abnormality without a specific sonographic correlate) proved to be successful in 3 women. Conclusion: Ultrasound‐guided 14g core biopsy established a malignant diagnosis in 91% of invasive cancers and in 48% of DCIS/pLCIS cases. This relatively non‐invasive, technically easy to perform and low‐cost biopsy procedure can be used immediately when targeted ultrasound shows a correlate for a suspicious MRI scan finding. Careful imaging‐pathologic correlation is required after 14g biopsy, and a discordant result will usually prompt recourse to an MRI‐guided VAB or hook‐wire localisation. [ABSTRACT FROM AUTHOR]

Purpose: Tumour-stroma ratio (TSR) is an important prognostic and predictive factor in several tumour types. The aim of this study is to determine whether TSR evaluated in breast cancer core biopsies is representative of the whole tumour., Method: Different TSR scoring methods, their reproducibility, and the association of TSR with clinicopathological characteristics were investigated in 178 breast carcinoma core biopsies and corresponding resection specimens. TSR was assessed by two trained scientists on the most representative H&E-stained digitised slides. Patients were treated primarily with surgery between 2010 and 2021 at Semmelweis University, Budapest., Results: Ninety-one percent of the tumours were hormone receptor (HR)-positive (luminal-like). Interobserver agreement was highest using 100 × magnification (κ core  = 0.906, κ resection specimen  = 0.882). The agreement between TSR of core biopsies and resection specimens of the same patients was moderate (κ = 0.514). Differences between the two types of samples were most frequent in cases with TSR scores close to the 50% cut-off point. TSR was strongly correlated with age at diagnosis, pT category, histological type, histological grade, and surrogate molecular subtype. A tendency was identified for more recurrences among stroma-high (SH) tumours (p = 0.07). Significant correlation was detected between the TSR and tumour recurrence in grade 1 HR-positive breast cancer cases (p = 0.03)., Conclusions: TSR is easy to determine and reproducible on both core biopsies and in resection specimens and is associated with several clinicopathological characteristics of breast cancer. TSR scored on core biopsies is moderately representative for the whole tumour., (© 2023. The Author(s).)

OBJECTIVE: Pre-operative diagnosis using core biopsy (CB) is one of the goals of the current approach for breast cancer, to learn the biological behavior of the tumor and reduce the costs by appropriate treatment planning. METHODS: The histologic type, grade, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status of 201 patients were recorded for both the CB and excision specimens and compared with each other. RESULTS: When we compared both materials, we found 89% concordance for histologic type and 75% for grade. There was a strong concordance for ER, PR, and HER2 status (96%, 89%, and 96%, respectively). CONCLUSION: Higher rates of ER, PR, and HER2 positivity in core biopsies may be related to easier fixation, shorter unfixed time, or taking the CB from the tumor periphery. The CB is a reliable tool for pre-operative diagnosis and management of the breast cancer treatment. However, because of the CB may not represent the entire tumor, final decision for histologic type and grade should be made on excision specimens. Although it is low, the discordance rates in terms of hormone receptor (HR) and HER2 expression between two materials should be considered. If there is a discordance between histological type/grade and HR/HER2 status, especially in HR and HER2 negative cases, these studies should be repeated in the excision material. Internal and external controls should be used during immunohistochemical study, attention should be paid during fixation. [ABSTRACT FROM AUTHOR]

Objective: To determine upgrade rates of lobular neoplasia (LN) to malignancy and evaluate factors that may predict upgrade.Methods: From 5/1/2003 to 12/30/2015, breast lesions diagnosed as LN (atypical lobular hyperplasia [ALH] or classic lobular carcinoma in-situ [LCIS]) on core biopsy that underwent surgical excision or at least 2 years imaging follow-up were identified. A subspecialty trained breast radiologist and pathologist reviewed imaging and pathology slides to confirm diagnosis and to determine if LN represented the target lesion, part of the target lesion, or an incidental finding. Imaging features, original BI-RADS final assessment category, biopsy method, biopsy device and final pathologic diagnosis were documented. Cases with both ALH and LCIS were classified as LCIS for analysis. Reason for biopsy of BI-RADS 2-3 was patient or referring physician preference. Upgrade rates to malignancy were determined for all cases.Results: In this study 73.7% (115/156) lesions were ALH and 26.3% (41/156) were LCIS+/-ALH. Surgical excision and imaging follow-up were performed in 71.2% (111/156) and 28.8% (45/156), respectively. Upgrade rates for ALH and LCIS were 0.0% (0/115) and 7.3% (3/41), respectively. Cancer developed at a site separate from core biopsy in 1.7% (2/115) ALH and 7.3% (3/41) LCIS cases. We found no association of upgrade rate with biopsy type, BI-RADS or target/part of target lesion versus incidental.Conclusion: Our study supports consideration of excision for LCIS, given 7.3% upgrade rate. Conversely, imaging surveillance might be appropriate following diagnosis of ALH alone. [ABSTRACT FROM AUTHOR]

Aim: To assess the horizontal and vertical dimensional changes of the alveolar ridge when using a collagen matrix in combination with collagen embedded xenogenic bone substitute, in comparison with natural healing after tooth extraction. Methods: Patients that required extraction in non‐molars areas were included. Test group‐15 sockets were treated with deproteinized bovine bone mineral containing 10% collagen (DBBM‐C), covered by a procaine collagen membrane (CMXs). Control group‐15 sockets left for spontaneous healing. We used a custom‐made acrylic stent as a reference for alveolar ridge measurements. Six‐month postoperative, a single implant was placed in the experimental site. A core biopsy was taken from the site, using a trephine bur. Histomorphometric analysis assessed bone area, connective tissue, bone marrow, and residual bone graft. Results: Six months later, horizontal ridge width at −3 mm showed a significant (p < 0.05) reduction in both groups albeit smaller in the test group 1.19 ± 1.55 mm, compared with the control 2.27 ± 1.52 (p = 0.087). At −5 mm sub‐crestally, statistically non‐significant reduction was noted in both groups, 1.61 ± 1.53 and 1.96 ± 1.52 mm for the test and control groups, respectively (p = 0.542). Vertical changes were smaller in the test group (0.14 ± 1.84 mm) compared with control (0.98 ± 1.49 mm). Keratinized tissue (KT) width was 7.3 ± 2.13 and 7.5 ± 3.49 mm in the test and control groups, respectively. Newly formed bone occupied 33.79 ± 17.37% and 51.14 ± 23.04% in the test and control groups, respectively, (p = 0.11). Connective tissue volume was 33.74 ± 13.81% and 30.12 ± 18.32% in the test and control groups, respectively (p = 0.65). Bone marrow occupied 19.57 ± 10.26% and 18.74 ± 17.15% in the test and control groups, respectively (p = 0.91). Residual graft occupied 12.9 ± 9.88% in the test group. Conclusion: Alveolar ridge preservation using DBBM‐C resulted in reductions of the vertical and horizontal dimensions albeit not reaching statistical significance. The larger than anticipated standard deviation and smaller inter‐group differences might account for this phenomenon. [ABSTRACT FROM AUTHOR]

Objective:This study aimed to find out valuable parameters that predict the nature of breast papillary lesions before excision, and we compared our results with those in the literature.Materials and Methods:We reviewed the medical records and pathology slides of patients diagnosed with papillary neoplasm after undergoing a core-needle biopsy between 2010 and 2020, who, subsequently, underwent surgical excision in a single tertiary care institution. The core biopsy results and pathology results of excision materials were compared with the radiological, pathological, and demographic findings.Results:A total of 51 patients were included in the study. According to the excision results, the patients were divided into two groups: the atypical group, which included 20 patients (39.3%), and the benign group, which included 31 patients (61.7%). The results of the core biopsy showed that the loss of myoepithelial cell layer was identified in 18 patients in the atypical group, while it was present in all patients in the benign group. Tumor sizes were larger and patient ages were older in the atypical group compared with the benign group. No significant difference was found between atypical and benign groups in terms of breast imaging-reporting and data system (BI-RADS) classification and location (right vs left; central vs peripheral). The upgrade rate was between 0% and 16% in literature, while it was 4% in our study.Conclusion:There is no consensus on whether patients diagnosed with papillary neoplasia as a result of core biopsy will undergo excision. According to our results, patients with following criteria should have their lesions excised: those who are advanced in age, those who are diagnosed with a papillary lesion as a result of core biopsies with loss of myoepithelial cell layer, and those who are diagnosed with large-sized lesions without loss of myoepithelial cell layer. Patients diagnosed with small-sized lesions without loss of myoepithelial cell layer and who are young in age are to be followed up without the need for lesion excision. The lesions should be adequately sampled.

Objectives: Measurement of the macroscopic visible core (MVC) length during macroscopic on‐site quality evaluation (MOSE) may allow estimation of sample adequacy for next‐generation sequencing (NGS), and prediction of correct diagnosis in endoscopic ultrasound‐guided tissue acquisition (EUS‐TA) of pancreatic masses. Methods: This multicenter prospective study included consecutive patients who underwent EUS‐TA for pancreatic masses using a 22‐G Franseen needle. MVC length and pathological samples obtained from two needle passes were analyzed on a per‐pass basis. Outcome measures included respective correlations of MVC length with histological sample quantity and diagnostic yields. Results: The analysis included 204 passes from 102 EUS‐TAs. MVC length correlated positively with histological sample quantity (P < 0.01). On the receiver operating characteristic curve for MVC length, the cut‐off value and area under the curve for obtaining a candidate sample for NGS were 30 mm and 0.74 (95% confidence interval [CI] 0.65–0.83), respectively. On multivariate analysis, MVC length ≥30 mm was a significant factor affecting suitability for NGS (odds ratio 6.19; 95% CI 2.72–14.10). Histologic diagnostic yield correlated positively with MVC length (P = 0.01); however, there was no positive correlation between MVC length and overall (histology plus cytology) diagnostic yield. Conclusions: Measuring MVC length to predict histological sample quantity on MOSE may be of clinical significance during EUS‐TA using a 22‐G Franseen needle. It may be an effective method, particularly while submitting samples for NGS. Registration: University Hospital Medical Information Network Trials Registry (UMIN000036528). [ABSTRACT FROM AUTHOR]

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspirate (TBNA) is a widely used method of minimally invasive lymph node sampling. The benefit of processing samples by cytologic methods versus "core biopsy" is unclear. It is unknown if safety or diagnostic yield varies by needle gauge. Between June 2018 and July 2019, 40 patients (56 lesions) undergoing EBUS TBNA lymph node evaluation were enrolled in this single-center prospective trial. Patients were chosen by permuted block randomization to undergo EBUS TBNA starting with 22-gauge (22g) or 19-gauge (19g) needles. Separate samples were sent for processing by cytologic methods and histopathology. Surgical pathologists and cytopathologists were blinded to needle size. The primary endpoint was diagnostic yield. Secondary endpoints compared specimen adequacy by rapid onsite evaluation (ROSE), sample adequacy for molecular testing, sample quality, and safety. Diagnostic yield for histopathologic examination was 87.5% and 83.9% for 19g and 22g respectively (P = 0.625). There was no significant difference in diagnostic yield by cytologic examination based on needle size. There was no significant difference in slide quality. Molecular adequacy for core-biopsy was 77% and 80% for 22g and 19g needles, respectively. Molecular adequacy for cytology cell block was 77% and 80% for 22g and 19g needles, respectively. There were no significant procedural complications. Both the 22g and 19g EBUS TBNA needles provided a similar diagnostic yield and clinical utility for ancillary testing. Processing techniques by cytologic methods or "core biopsy" showed no significant impact in diagnostic yield or utility of molecular testing. [ABSTRACT FROM AUTHOR]

Breast core biopsies are a standard component of the triple approach that includes clinical examination, imaging and tissue sampling. Conventional cores, diagnostic vacuum assisted biopsy and vacuum assisted excisions are established methods for sampling and managing breast lesions. It is important to be aware of the potential pitfalls in the technical handling and interpretation of the limited core biopsy samples. Here, we present a clinically oriented, well illustrated overview of the common diagnostic pitfalls based on the author's diagnostic and second opinion practice, emphasize the value of clinicopathological correlation and provide histological tips and clues with useful immunohistochemistry to aid the reporting pathologists in their daily interpretation of breast core biopsies. [ABSTRACT FROM AUTHOR]

Background: Recent studies have reported that melanoma antigen (MAGE) gene is expressed in a variety of cancers and testicular tissues. The expression of MAGE-A genes could be used for biomarkers with high tumor specificity; however, there is still a lack of data on most solid tumors. The objective of this study was to construct novel universal primers for detecting the mRNA of MAGE A1-10 genes in lung cancer patients. Method: We conducted this cross-sectional study in 2017 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. The specimens were a testicular tissue and 15 core biopsies of lung cancer tissues. We designed the universal primers to bind the mRNA of MAGE A1, A2, A2B, A3, A4, A5, A6, A8, A9, A9B, and A10 regions; the assay was performed by nested PCR and continued by direct sequencing. Results: Using the universal primer MAGE A1-10, the PCR was able to detect the MAGE A mRNA of 10 subtypes of MAGE A from testicular and lung cancer tissues. The sequences analysis of individual MAGE A1-10 showed the same homology with MAGE A from GenBank data. Among the 15 lung cancer patients, 13/15 (86.67%) tested positive for GAPDH; subsequently, they were considered for MAGE-A gene detection; while, those testing negative for GAPDH were excluded. The PCR results showed that 12/13 (92.31%) had positive MAGE A1-10 tests and 3/13 (23.08%) tested positive for MAGE A1-6. Conclusion: This finding showed that the novel universal primers could be applied as a new tool for detecting MAGE A1-10 expression in cancer cells.

High‐throughput molecular profiling of solid tumours using core needle biopsies (CNB) allows the identification of actionable molecular alterations, with around 70% success rate. Although several studies have demonstrated the utility of small biopsy specimens for molecular testing, there remains debate as to the sensitivity of the less invasive fine‐needle aspiration (FNA) compared to CNB to detect molecular alterations. We aimed to prospectively evaluate the potential of FNA to detect such alterations in various tumour types as compared to CNB in cancer patients included in the SHIVA02 trial. An in‐house amplicon‐based targeted sequencing panel (Illumina TSCA 99.3 kb panel covering 87 genes) was used to identify pathogenic variants and gene copy number variations (CNV) in concomitant CNB and FNA samples obtained from 61 patients enrolled in the SHIVA02 trial (NCT03084757). The main tumour types analysed were breast (38%), colon (15%), pancreas (11%), followed by cervix and stomach (7% each). We report 123 molecular alterations (85 variants, 23 amplifications and 15 homozygous deletions) among which 98 (80%) were concordant between CNB and FNA. The remaining discordances were mainly related to deletions status, yet undetected alterations were not exclusively specific to FNA. Comparative analysis of molecular alterations in CNB and FNA showed high concordance in terms of variants as well as CNVs identified. We conclude FNA could therefore be used in routine diagnostics workflow and clinical trials for tumour molecular profiling with the advantages of being minimally invasive and preserve tissue material needed for diagnostic, prognostic or theranostic purposes.

Abstract Background Management of pure intraductal papillomas (IDP) without atypia diagnosed on core needle biopsy (CNB) remains controversial given highly variable rates of upgrade in the literature. Aim We sought to identify clinical and histologic factors that predict upgrade to atypia or malignancy in a large population. Methods and results A retrospective review was performed of all cases of pure IDP diagnosed on CNB and then surgically excised at a single institution from 2008 to 2018. Clinical, radiologic, and pathologic factors were compared in the no upgrade, upgrade to atypia, or upgrade to cancer groups. Univariate analysis was performed comparing no upgrade and upgrade to cancer or atypia. Four hundred and thirty nine patients were identified with a total of 490 IDP and a median age of 50 years (range 16–85). Of these patients, 54 (12.3%) were upgraded to atypia after surgical excision and five (1.1%) were upgraded to cancer. The presence of multiple papillomas in a single patient was a significant predictor of upgrade to cancer or atypia (p