Assessment of Diagnostic Accuracy of Fine Needle Aspiration Cytology in the Benign and Malignant Palpable Breast Lesions and its Concordance with the Histopathological Correlation in Regards to the Age, Sex, Locus and Circumstances

Background: Breast lumps constitute a significant proportion of surgical cases in both developed and developing countries. Fine Needle Aspiration Cytology (FNAC) is a simple, minimally invasive, cost effective, outpatient based and a rapid diagnostic method for breast lesions. The aim of the present study was to study the cytological spectrum, cytohistological correlation and diagnostic accuracy of aspiration cytology (FNAC) in palpable breast lesions. Material and Methods: This was a prospective study done in the department of Pathology, L.N. medical college, Bhopal, India from January 2016 to December 2016. FNAC of 300 cases of palpable breast lesions were done and reported by expert pathologist. The histopathological specimen when available were reported by other pathologist without prior knowledge. Sensitivity, specificity and accuracy of FNA diagnosis were then analyzed. Results: A total of 300 cases of breast lesion were diagnosed on FNA, out of them histopathological correlation was available for 150 cases. Benign breast lesions are more common in younger patients in 11-30 age group and Malignant breast lesion are more common in old age group patients of 41-60 yrs age group. Benign breast lesions were found in 215 cases (71.66%); among which fibroadenoma (41%) was the commonest lesion observed. Malignancy was observed in 63 cases (21%); among them, Ductal carcinoma was the predominant lesion (17.66%). The sensitivity, specificity and diagnostic accuracy of FNAC for malignant lesion is found to be 98.3%, 98.9% and 98.7% respectively. Conclusion: FNAC is an effective and valid tool as first line diagnostic modality in preoperative diagnosis of malignant and benign breast lesions.

Optimal acquisition time to discriminate between breast cancer subtypes with contrast-enhanced cone-beam CT

Background: Fine needle aspiration cytology (FNAC) or core biopsy form an integral component of the triple test which is being performed as a pre-operative test to evaluate breast lump. Aim: To study the cytomorphological pattern of breast lesions in a tertiary care hospital of Central India and to find out the accuracy of FNAC in diagnosing benign and malignant lesions of breast. Method: 200 patients presenting as breast lumps were evaluated by FNAC and correlated with histology. Result: Fibroadenoma was most common benign lesion while Infiltrating duct carcinoma was most common malignant lesion reported. Sensitivity of FNAC was 99.25% for benign lesions and 95% for malignant lesions. Specificity and PPV of FNAC in diagnosing benign lesions were 95% and 97.79% respectively while that for malignant cases were 99.25% and 98.27% respectively. The diagnostic accuracy of FNAC was 97.94% in the present study. Conclusion: FNAC serves as a rapid, economical and reliable tool for the evaluation of breast lumps. Key words: Fine needle aspiration cytology, Benign breast lesions, Malignant breast lesions, FNAC

To determine the diagnostic performance of volumetric quantitative dynamic contrast-enhanced MRI (qDCE-MRI) in differentiation between malignant and benign breast lesions. DCE-MRI was performed in 124 patients with 136 breast lesions. Quantitative pharmacokinetic parameters Ktrans, Kep, Ve, Vp and semi-quantitative parameters TTP, MaxCon, MaxSlope, AUC were obtained by using a two-compartment extended Tofts model and three-dimensional volume of interest. Morphologic features (lesion size, margin, internal enhancement pattern) and time-signal intensity curve (TIC) type were also assessed. Logistic regression analysis was used to determine predictors of malignancy, followed by receiver operating characteristics (ROC) analysis to evaluate the diagnostic performance. qDCE parameters (Ktrans, Kep, Vp, TTP, MaxCon, MaxSlope and AUC), morphological parameters and TIC type were significantly different between malignant and benign lesions (P≤0.001). Multivariate logistic regression analyses showed that Ktrans, Kep, MaxSlope, size, margin and TIC type were independent predictors of malignancy. The diagnostic accuracy of logistic models based on qDCE parameters alone, morphological features plus TIC type, and all parameters combined was 94.9%, 89.0%, and 95.6% respectively. qDCE-MRI can be used to improve diagnostic differentiation between benign and malignant breast lesions in relation to morphology and kinetic analysis. • qDCE-MRI parameters are useful for discriminating between malignant and benign breast lesions. • K trans , K ep and MaxSlope were independent predictors of breast malignancy. • qDCE-MRI has a better diagnostic ability than morphology and kinetic analysis. • qDCE-MRI can be used to improve the diagnostic accuracy of breast malignancy.

The aim of the present study was to assess the performance of contrast-enhanced ultrasound in distinguishing between malignant and benign breast lesions and the diagnostic value of its clinical application. A total of 52 cases with malignant breast tumors and 73 cases with benign breast lesions were included in the study. Time-intensity curves (TICs) for contrast-enhanced ultrasound were recorded, and the perfusion parameters were obtained and analyzed. Typical features of malignant breast tumors included irregular shape and vascular morphology, uneven contrast agent distribution, filling defects and contrast agent retention, ‘fast-out’ wash-out mode, unclear boundaries and uneven internal echo. Benign lesions were characterized by ‘slow-out’ or synchronous wash-out mode. Regarding perfusion, the starting time of the perfusion of the Sone-Vue microbubble contrast (always 20-30 sec) and time to peak (TTP) were significantly earlier for the malignant lesions, while the wash-out time was later. A significantly greater peak intensity, rising slope and area under the TIC were observed for the malignant breast lesions. All of the malignant breast lesions exhibited an enlarged focus scope on ultrasound, while no obvious focus scope enhancement was observed for benign breast lesions. Furthermore, the TICs of 88.4% of malignant breast lesions were of the fast-rising and slow-declining type, while the TICs of 75.3 and 17.8% of the benign breast lesions were of the slow-rising and fast-declining, and fast-rising and fast-declining type, respectively. Receiver operating characteristics analysis indicated that the TTP, wash-out time and rising slope might contribute to the differential diagnosis between malignant and benign breast lesions. In conclusion, TIC parameters of contrast-enhanced ultrasound have promising clinical value in differentiating between malignant and benign breast lesions. The TTP, wash-out time and rising slope may contribute to the diagnosis of patients with breast lesions to facilitate timely treatment and prognostication of breast cancer patients.

The aim of this study was to apply spatiotemporal analysis of contrast-enhanced ultrasound (CEUS) loops to quantify the enhancement heterogeneity for improving the differentiation between benign and malignant breast lesions. This retrospective study included 120 women (age range, 18-82 years; mean, 52 years) scheduled for ultrasound-guided biopsy. With the aid of brightness-mode images, the border of each breast lesion was delineated in the CEUS images. Based on visual evaluation and quantitative metrics, the breast lesions were categorized into four grades of different levels of contrast enhancement. Grade-1 (hyper-enhanced) and grade-2 (partly-enhanced) breast lesions were included in the analysis. Four parameters reflecting enhancement heterogeneity were estimated by spatiotemporal analysis of neighboring time-intensity curves (TICs). By setting the threshold on mean parameter, the diagnostic performance of the four parameters for differentiating benign and malignant lesions was evaluated. Sixty-four of the 120 patients were categorized as grade 1 or 2 and used for estimating the four parameters. At the pixel level, mutual information and conditional entropy present significantly different values between the benign and malignant lesions (p < 0.001 in patients of grade 1, p = 0.002 in patients of grade 1 or 2). For the classification of breast lesions, mutual information produces the best diagnostic performance (AUC = 0.893 in patients of grade 1, AUC = 0.848 in patients of grade 1 or 2). The proposed spatiotemporal analysis for assessing the enhancement heterogeneity shows promising results to aid in the diagnosis of breast cancer by CEUS. The proposed spatiotemporal method can be developed as a standardized software to automatically quantify the enhancement heterogeneity of breast cancer on CEUS, possibly leading to the improved diagnostic accuracy of differentiation between benign and malignant lesions. • Advanced spatiotemporal analysis of ultrasound contrast-enhanced loops for aiding the differentiation of malignant or benign breast lesions. • Four parameters reflecting the enhancement heterogeneity were estimated in the hyper- and partly-enhanced breast lesions by analyzing the neighboring pixel-level time-intensity curves. • For the classification of hyper-enhanced breast lesions, mutual information produces the best diagnostic performance (AUC = 0.893).

Objective To evaluate the application of high b-value diffusion weighted imaging (DWI) and ADC values for malignant and benign breast lesions.Methods There were 165 patients with 171 suspicious malignant breast lesions received low and high b-value ( 500 and 1500 s/mm2 ) DWI scan before dynamic contrast-enhanced MRI (DEC-MRI).Using normal breast as the reference base,the signal intensity and ADC values of the 171 lesions on high-b-value ( b = 1500 s/mm2 ) DWI were retrospectively analyzed If a lesion showed abnormal enhancement on DCE-MRI and high signal intensity on high-b-value (b = 1500 s/mm2 ) DWI,that lesion was defined as positive result on behalf of malignant lesion; the otherwise was defined as negative result on behalf of benign lesion.ADC values were calculated for the 111 lesions with positive results on DWI.And all lesions received a biopsy after MR scan.References to the histopatholngical results,the amounts of positive and negative results on high-b value DWI were recorded.Using 1.13 × 10 -3mm2/s as the cutoff value,the sensitivity and specificity of ADC value for the diagnosis of malignant breast lesion were calculated.Fisher exact tests and Wilcoxon rank sum tests were used for statistical analyses.Results There are 91 malignant and 80 benign lesions the 171 lesions confirmed by histopathology.On high-b value DWI,139 lesions were visually positive results,including 83 malignant and 56 benign lesions.Other 32 lesions were visually negative results,including 24 benign lesions and 8 malignant lesions (non-mass ductal carcinoma in situ).There are statistically significant difference between malignant and benign lesions ( P ＜ 0.01 ).All invasive carcinoma and mass-forming DCIS were visually positive results,whereas eight non-mass DCIs lesions were visually negative results,the overall sensitivity and specificity were 91.2％ (83/91)and 30.0％ (24/80),respectively.In the 111 lesions with DWI positive result ( 110 mass lesions and one focal lesion),the mean ADC value of the 63 malignant lesions was (0.73 ±0.24) × 10-3 mm2/s,whereas the mean ADC value of the 48 benign lesions was( 1.19 ±0.42) ×10-3 mm2/s.There was statistically significant difference between benign and malignant lesions (Z =5.818,P ＜0.01 ).When ADC value of 1.13 × 10-3 mm2/s was chosen as the cutoff value,61 malignant lesions were true positive results,2 mucinous carcinoma were false-negative results,27 benign lesions were true negative results,21 benign lesions were false-positive results,the sensitivity and specificity was 96.8％(61/63) and 56.2％ (27/48),respectively.Conclusions High b-value DWI and ADC values were useful for distinguishing of malignant and benign breast lesions,but it should be cautious when it was used for the diagnosis of non-mass breast lesions. Key words: Breast neoplasms; Magnetic resonance imaging; Comparative study

Value of micro-flow imaging and high-definition micro-flow imaging in differentiating malignant and benign breast lesions

Data mining framework for breast lesion classification in shear wave ultrasound: A hybrid feature paradigm

To evaluate the value of diffusion-weighted imaging (DWI) in distinguishing between benign and malignant breast lesions. Fifty-two female subjects (mean age = 58 years, age range = 25-75 years) with histopathologically proven breast lesions underwent DWI of the breasts with a single-shot echo-planar imaging (EPI) sequence using large b values. The computed mean apparent diffusion coefficients (ADCs) of the breast lesions and cell density were then correlated. The ADCs varied substantially between benign breast lesions ((1.57 +/- 0.23) x 10(-3) mm(2)/second) and malignant breast lesions ((0.97 +/- 0.20) x 10(-3) mm(2)/second). In addition, the mean ADCs of the breast lesions correlated well with tumor cellularity (P < 0.01, r = -0.542). The ADC would be an effective parameter in distinguishing between malignant and benign breast lesions. Further, tumor cellularity has a significant influence on the ADCs obtained in both benign and malignant breast tumors.

Objective To discuss the value of conventional ultrasound combined with virtual touch tissue imaging (VTI) in differentiating benign and malignant breast lesions by breast imaging reporting and data system (BI-RADS) diagnostic criteria. Methods From January 2013 to October 2014, 395 breast lesions from 389 patients from the Tenth People's Hospital, Tongji University were included in present study. All the lesions were confirmed by surgery pathology. Conventional ultrasound and VTI examinations were done before surgery. Both benign and malignant lesions were classified into varied categories based on the boundary of lesions under VTI mode. Benign and malignant breast lesions were classified into BI-RADS categories by conventional ultrasound or conventional ultrasound combined with VTI. The χ2 test was used to compare the differences of lesions′ boundaries between VTI categories and VTI mode. The pathology findings were used as golden criteria, to calculate the sensitivity, specificity and accuracy of conventional ultrasound as well as conventional ultrasound combined with VTI. And their diagnostic performances were compared by McNemar′s test. Results Of 395 breast lesions, 282 (71.4%) were benign, 113 (28.6%) were malignant. 75.5% (213/282) benign lesions were classified as Ⅱ-Ⅲ under VTI mode, while 83.2% (94/113) malignant lesions were classified as Ⅳ-Ⅴ under VTI mode. The differences in classification between them was statistically significant (χ2=114.759, P<0.01). 77.7% (219/282) benign lesions had unclear boundaries under VTI mode, while 78.8% (89/113) malignant lesions had clear boundaries under VTI mode. The differences in boundaries between them was statistically significant (χ2=108.480, P<0.01). The sensitivity, specificity and accuracy of conventional ultrasound in differentiating benign and malignant breast lesions were 97.3%, 54.2% and 66.6% respectively; while the sensitivity, specificity and accuracy of conventional ultrasound combined with virtual touch tissue imaging in differentiating benign and malignant breast lesions were 98.2%, 84.4% and 88.4% respectively. The specificity and accuracy were higher when only using conventional ultrasound with statistical significance (χ2=79.425, 67.549, both P<0.01); however the sensitivity had no significantly different (χ2=11.974, P<0.01). Conclusion Conventional ultrasound combined with virtual touch tissue imaging can improve the specificity and the accuracy in differentiating benign and malignant breast lesions. Key words: Elasticity imaging techniques; Ultrasonography; Breast diseases; Diagnosis, differential

IntroductionBreast cancer is one of the leading causes of cancer deaths in female patients. Breast lesions can have various morphological diversities, ranging from benign to in situ to malignant. An important histopathological feature that distinguishes benign and malignant lesions is the presence or absence of the myoepithelial cell layer. The tumor protein p63 has been characterized as a reliable immunohistochemical marker and is uniquely displayed in the myoepithelial cells of breast parenchyma. Hence, it helps distinguish benign from malignant lesions.AimTo study the value of the immunohistochemical expression of p63 in the diagnosis of breast lesions, to investigate p63 expression in benign and malignant breast lesions, and to assess if loss of p63 expression is consistently associated with invasive disease.Materials and methodsAbout 98 cases of breast disease were studied, of which 86 were subjected to immunohistochemical staining for p63 and analyzed for its expression, and the staining arrangement was interpreted.ResultsOut of 86 cases, there were 46 benign and 40 malignant breast lesions. Immunohistochemical staining for p63 in the benign lesions showed continuous positivity with a score of three in 30 cases and discontinuous positivity with a score of two in 16 cases. In malignant lesions, p63 was not expressed and scored zero in 35 cases and discontinuous positive with a score of one in five cases. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of p63 in distinguishing the benign from the malignant lesions was 100%, 87.50%, 90.20%, 100%, and 94.19% respectively.ConclusionThere is a statistically significant difference in the expression of p63, a specific nuclear marker for myoepithelial cells, in benign and malignant breast lesions. It was consistently positive in benign breast lesions and negative in the majority of malignant breast lesions. Thus, p63 can act as a helpful immunohistochemical marker in categorizing histopathologically-difficult cases into benign or malignant ones.

Breast cancer is the most common malignant tumor in women and a quantitative contrast-free method is highly desirable for its diagnosis. To investigate the performance of quantitative MRI in differentiating malignant from benign breast lesions and to compare with the Breast Imaging Reporting and Data System (BI-RADS). Retrospective. Eighty patients (56 with malignant lesions and 24 with benign lesions). Diffusion-weighted imaging (DWI) with a single-shot echo planar sequence and synthetic MRI with magnetic resonance image compilation (MAGiC) were performed at 3T. T1 relaxation time (T1 ), T2 relaxation time (T2 ), and proton density (PD) from synthetic MRI and apparent diffusion coefficient (ADC) from DWI were analyzed by two radiologists (Reader A, Reader B). Univariable and multivariable models were developed to optimize differentiation between malignant and benign lesions and their performances compared to BI-RADS. The diagnostic performance was evaluated using multivariate logistic regression analysis and area under the receiver operating characteristic (ROC) curves (AUC). T2 , PD, and ADC values for malignant lesions were significantly lower than those in benign breast lesions for both radiologists (all P < 0.05). The combined T2 , PD, and ADC model had the best performance for differentiating malignant and benign lesions with AUC, sensitivity, specificity, positive predictive value, and negative predictive values of 0.904, 94.6%, 87.5%, 94.6%, and 87.5%, respectively. The corresponding results for BI-RADS were no AUC, 94.6%, 75.0%, 89.8%, and 85.7%, respectively. The approach that combined synthetic MRI and DWI outperformed BI-RADS in the differential diagnosis of malignant and benign breast lesions and was achieved without contrast agents. This approach may serve as an alternative and effective strategy for the improvement of breast lesion differentiation. 3. 3.

Background: Breast cancer is the common malignant lesion in women. Fine needle aspiration cytology has high sensitivity and specificity and is a simple, rapid and safe method to diagnose breast lesions. The aim of the study was to categorize breast lesions and correlate the Fine needle aspiration cytology diagnosis with histopatholoical findings. Materials and Methods: This was a retrospective study done in department of Pathology of Institute of medicine, Trivuwan university teaching hospital, from January 2007 to December 2010. There were 1403 FNAC cases and 469 histopathology cases. Fine needle aspiration correlation with histopathology was done in 249 cases. All the cases were categorized according to risk for cancers: Unsatisfactory sample, Inflammatory breast disease Benign proliferative breast disease without atypia, Benign proliferative breast disease with atypia, Suspicious for malignancy and Malignant lesions. Results: Benign breast lesions were common in the age group of 21-30 years and malignant breast lesion common in the age of 41-50 years of age. In our study fibroadenoma was most common benign lesion and ductal carcinoma was the most common malignant lesion. The sensitivity and specificity of FNAC for malignancy were found to be 98.2% and 98.5% respectively. Conclusion: Fine needle aspiration cytology is highly sensitive and specific technique for diagnosis of most of the malignant and benign breast lesions. Keywords: Fine needle aspiration cytology; Breast lesion; Breast cancer; Fibroadenoma DOI: http://dx.doi.org/10.3126/jpn.v1i2.5408 JPN 2011; 1(2): 131-135

The added value of qualitative and quantitative diffusion-weighted magnetic resonance imaging (DW-MRI) in differentiating benign from malignant breast lesions