Accuracy Of Core Needle Biopsy Research Articles

Core needle biopsy versus incisional biopsy for differentiation of soft-tissue sarcomas: A systematic review and meta-analysis.

Controversies exist regarding the biopsy technique of choice for the accurate diagnosis of soft-tissue sarcoma (STS). The objective of this systematic review and meta-analysis was to compare the diagnostic accuracy of core needle biopsy (CNB) versus incisional biopsy (IB) in STS with reference to the final histopathological result. Studies regarding the diagnostic accuracy of CNB and IB in detecting STS were searched systematically in the MEDLINE and EMBASE databases. Estimates of sensitivity and specificity with associated 95% CIs for diagnostic accuracy were calculated. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2). A total of 17 studies comprising 2680 patients who underwent 1582 CNBs and 241 IBs with subsequent tumor resection met the inclusion criteria. The sensitivity and specificity of CNB and IB to detect the dignity of lesions were 97% (95% CI, 95%-98%) and 99% (95% CI, 97%-99%), respectively, and 96% (95% CI, 92%-99%) and 100% (95% CI, 94%-100%), respectively. Estimates of the sensitivity and specificity of CNB and IB to detect the STS histotype were 88% (95% CI, 86%-90%) and 77% (95% CI, 72%-81%), respectively, and 93% (95% CI, 87%-97%) and 65% (95% CI, 49%-78%), respectively. Patients who underwent CNB had a significantly reduced risk of complications compared with patients who underwent IB (risk ratio, 0.14; 95% CI, 0.03-0.56 [P≤.01). Quality assessment of studies revealed a high risk of bias. CNB has high accuracy in diagnosing the dignity of lesions and STS histotype in patients with suspected STS with fewer complications compared with IB. Therefore, CNB should be regarded as the primary biopsy technique.

Accuracy of core needle biopsy compared to fine needle biopsy for the diagnosis of neoplasm in patients with suspected head and neck cancers: a systematic review protocol of diagnostic test accuracy.

The objective of this review is to determine the difference in diagnostic accuracy of core needle biopsy and fine needle aspiration for patients with a head and neck mass using surgical histopathology as a reference test. The risks and adverse events associated with each technique will also be compared. Tissue diagnosis is critical in evaluation of head and neck lesions to guide management. Options for tissue biopsy include surgical biopsy, fine needle aspiration and core needle biopsy. Studies that compare ultrasound-guided core needle biopsy and/or fine needle aspiration to investigate lumps in the thyroid, cervical lymph nodes, or salivary glands for malignancy in adult patients will be included. The comparator test will be definitive histology in form of surgical biopsy/excision. MEDLINE, Emcare, Embase, Web of Science and Cochrane Register of Diagnostic Accuracy Studies will be searched. Studies will be critically appraised by two independent reviewers for methodological quality, using the modified critical appraisal instrument QUADAS-2 and JBI SUMARI software. Two independent reviewers will extract data from papers included in the review using the standardized data extraction tool available in the JBI Reviewer's Manual. PROSPERO CRD42020140005.

The determination of specificity, sensitivity and accuracy of core needle biopsy in the diagnosis of parotid and submandibular salivary glands tumors

Background/Aim. The diagnosis of tumors of salivary glands relies heavily on radiological examination and biopsy of pathological tissue. The aim of this study was to investigate the sensitivity, specificity and accuracy of core needle biopsy in diagnosis of tumors of parotid and submandibular glands. Methods. This study was designed as a crosssectional clinical trial performed between May 2008 and ?ay 2015 at the Department of Otorhinolaryngology and Maxillofacial Surgery, Clinical Center Zemun, Belgrade, Serbia. The examinations included 200 patients among which 100 were diagnosed with tumors of parotid salivary glands and 100 with tumors of submandibular salivary glands. The core needle biopsy was undertaken in all cases where tumor was smaller than 2 cm, far from blood vessels and far from the deep layer of parotid gland. The histopathological analysis was performed to identify histological type of the lesion. Upon performing the surgical procedure and consequently the tumor tissue extirpation, tissue samples obtained were investigated for the definitive diagnosis. Results. The sensitivity of the procedure was 90.9% for parotid salivary gland and 74% for submandibular salivary gland, the specificity was 95.9% for parotid salivary gland and 93% for submandibular salivary gland and the accuracy was 94.7% for parotid salivary gland and 87% for submandibular salivary gland. Based on the histopathological findings of the salivary glands obtained using core needle biopsy of the tumor tissue, it was possible to differentiate between malignant and benign lesions. Conclusion. Current investigation points to the advantages and efficiency of core needle biopsy in diagnosis of tumors of parotid and submandibular salivary glands.

A meta-analysis supports core needle biopsy by radiologists for better histological diagnosis in soft tissue and bone sarcomas.

Background:Although surgical biopsy has historically been considered to be the standard diagnostic biopsy for soft tissue and bone sarcomas, recent literature suggests that percutaneous core needle biopsy yields similar results. Therefore, an evaluation of the exact diagnostic accuracy and associated influential variables of core needle biopsy that is based on a large data set would be useful.Methods:We searched MEDLINE, Web of Science, and EMBASE to identify core needle biopsy studies for predicting final histological subtypes of musculoskeletal lesions. The diagnostic accuracies of core needle biopsy and of surgical biopsy were assessed and compared by using random-effect meta-analyses. The factors relevant to diagnostic accuracy were evaluated by meta-regression and subgroup analyses.Results:We selected 32 studies comprising 7209 musculoskeletal lesions. The pooled proportion estimate for the diagnostic accuracy of core needle biopsy was 0.84 (95% confidential interval, CI: 0.81–0.87), which indicated an approximate 84% concordance between core needle biopsy results and final histological diagnoses. The findings of meta-regression and subgroup analyses suggested that radiologists were better core needle biopsy operators than surgeons. An additional meta-analysis for direct comparison between core needle biopsy and surgical biopsy demonstrated that diagnostic accuracy was significantly lower for core needle biopsy than for surgical (pooled odds ratio: 0.39, 95% CI: 0.20–0.76).Conclusion:Our results suggested that core needle biopsy should be performed by expert radiologists and that surgical biopsy should be performed if diagnosis following core needle biopsy does not match the clinical presentation and radiographic findings

Abstract 1601: Clinical studies to treat without surgery for breast cancer cases who achieved clinical complete response by neoadjuvant chemotherapy

Abstract Introduction: The pathological complete response (pCR) rate is approaching to 50% particularly in patients with hormone-receptor negative disease by neoadjuvant chemotherapy (NAC). If the disease is not recurred locally in cases with pCR and pCR could be accurately diagnosed preoperatively, it is possible to treat some population of patients without surgery after NAC. We conducted two studies to examine: 1) outcomes of patients who had achieved pCR by NAC with a special attention to local recurrence. 2) diagnostic accuracy of pCR with core needle biopsy (CNB) for cases obtained clinical complete response (cCR) by NAC. Methods: 1) Clinical outcomes were retrospectively investigated in 395 patients who achieved pCR from 1599 patients with primary operable breast cancer treated by NAC (overall pCR rate of 24.7%: 395/1599). The association of clinic-pathological factors with recurrence was investigated. 2) Ultrasound-guided CNB was performed prospectively for 86 cases who achieved cCR by MRI after NAC. The concordance of pathological results between CNB and surgical specimens was examined. The pathological diagnosis was categorized as no carcinoma (pCR), carcinoma in situ (CIS) and invasive carcinoma (INV). Results: 1) 395 pCR cases consisted of 50 Luminal type (pCR rate: 7.2%), 98 Luminal-HER2 type (32.1%), 116 HER2 type (52.5%), and 131 triple negative (TN) type (34.2%). The median follow-up was 41 months. Recurrent diseases including local recurrence or distant metastasis were found in 5.80% (23/395). According to subtypes, these were 2.00% (1/50) for Luminal type, 4.08% (4/98) for Luminal-HER2 type, 10.3% (12/116) for HER2 type, and 4.58% (6/131) for TN type. Local recurrence was found in 1.2% of cases (5/395). Risk factors of recurrence were clinical stage before NAC and nodal status after NAC in the univariate analysis, and only clinical stage remained statistically significant in the multivariate analysis. 2) Pathology of surgical specimen revealed pCR in 41 cases (48%), CIS in 17 cases (20%) and INV in 28 cases (32%). Discordant cases: pCR in CNB, but CIS and INV in surgical specimens were found in 24 cases (14 CIS and 10 INV). The false negative rate (FNR) and accuracy of CNB to predict INV were 22.2% and 88.4%, respectively. Conclusion: Except HER2 type, recurrence was not frequent particularly in cases with an early clinical stage. Local recurrence was rarely observed in any subtype. However, ultrasound-guided CNB for cCR cases diagnosed by MRI was not reliable enough to predict pCR. Thus, imaging diagnosis and biopsy methods need to be improved to achieve 10% of FNR and 90% of accuracy for predicting pCR and to proceed to an observational study without performing surgery. Citation Format: Takashi Ishikawa, Mariko Asaoka, Kazutaka Narui, Akimitsu Yamada, Nobuyasu Suganuma, Takashi Chishima, Takahiko Kawate, Kana Miyahara, Kazuaki Takabe, Yasushi Ichikawa, Eiichi Sato. Clinical studies to treat without surgery for breast cancer cases who achieved clinical complete response by neoadjuvant chemotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1601.

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Objective: This study evaluated the prevalence of nondiagnostic results, diagnostic performance, and complications of core-needle biopsy (CNB) compared with repeat fine-needle aspiration (FNA) for thyroid nodules with previous nondiagnostic FNA findings.Methods: The Ovid-MEDLINE and EMBASE databases were thoroughly searched for studies evaluating CNB or repeat FNA for thyroid nodules with initially nondiagnostic FNA results. Pooled proportions of nondiagnostic results of CNB and repeat FNA were calculated. A meta-analysis was performed to evaluate the diagnostic accuracy of CNB and repeat FNA for a diagnosis of malignancy using a bivariate random-effects model. Complication rates were also evaluated.Results: A review of 52 articles identified 4 eligible articles, involving 1,028 patients with 1,028 thyroid nodules, which were included in the meta-analysis. CNB demonstrated significantly lower rates of nondiagnostic results (6.4%) than repeat FNA (36.5%) (P<.0001). In the 3 studies that analyzed the diagnostic accuracy of CNB in diagnosing malignancy, CNB demonstrated significantly higher summary estimates of sensitivity (89.8%) than repeat FNA (60.6%) (P = .022), but summary specificity did not differ between CNB (99.2%) and repeat FNA (99.0%) (P = .576). None of the patients who underwent CNB or repeat FNA experienced any major complications.Conclusion: CNB demonstrates lower rates of nondiagnostic results and higher diagnostic accuracy than repeat FNA. CNB, rather than repeat FNA, can be utilized to diagnose thyroid nodules previously nondiagnostic on FNA.Abbreviations:CI = confidence intervalCNB = core-needle biopsyFNA = fine-needle aspirationSROC = summary receiver operating characteristicUS = ultrasound

Safety and Accuracy of Core Needle Biopsy for Soft Tissue Masses in an Ambulatory Setting.

Background Percutaneous needle biopsy has been found to be a safe and accurate method for the initial investigation of soft tissue masses. The notion exists that needle biopsies should be performed in specialized sarcoma centers, which can place a financial burden on patients without a sarcoma center near their place of residence. There is no consensus in the current literature regarding the diagnostic accuracy and clinical utility of clinic-based percutaneous core needle biopsy performed by community orthopedic surgeons with fellowship training in musculoskeletal oncology. Questions/Purposes Our primary goal was to determine if office-based core needle biopsy of soft tissue masses could safely yield accurate diagnoses when performed by a community orthopedic surgeon with fellowship training in musculoskeletal oncology. Patients and Methods We retrospectively reviewed the charts of 105 patients who underwent percutaneous core needle biopsy of soft tissue masses in a community clinic. All procedures were performed by one fellowship-trained musculoskeletal oncologist. Accuracy of the initial clinic-based needle biopsy was determined through comparison to the results of pathological analysis of the surgically excised masses. Final data analysis included 69 patients who underwent both clinic-based biopsy and subsequent surgical excision of their masses. Results We found clinic-based biopsies to be 87.0% accurate for exact diagnosis and 94.2% accurate in determining whether the mass was benign or malignant (p < 0.0001). Minor complications related to the clinic-based biopsy occurred in 5.80% of cases, with no documentation of major complications. Conclusions Our results provide evidence that office-based percutaneous biopsy can be administered safely and yield accurate, clinically useful results when performed by a fellowship-trained musculoskeletal oncologist.

Abstract P3-02-01: Impact of prognoses on the discrepancies in histological grade of breast cancer between core needle biopsy and surgical excision specimen

Abstract Purpose: The high reliability and utility of core needle biopsy (CNB) have been previously described. Histological grade in CNB is one of the main determinants of the need for neoadjuvant systemic therapy. Our aim in this study was to clarify the host and histopathological factors influencing the discrepancies in histological grade (HG) between CNB and surgically excision specimen (SES). Methods: A total of 1342 operable invasive breast carcinoma biopsies were assessed and compared with surgical specimens in our hospital. Patients who required neoadjuvat chemotherapy were excluded. Histological grade (tubule formation, nuclear pleomorphism and mitotic index) was assessed between paired CNB and SET samples. ER and PgR status were determined using immunohistochemistry(IHC). HER2 status was determined using IHC and scored from 0 to 3+. Fluorescence in-situ hybridization analysis was carried out in HER2 2+ cases. The cut off point for ER and PgR positivity was set at 1%. Results: The clinicopathological characteristics of tumors showed in Clinico-pathological characteristics of 1342 patients and tumors by discordance group between CNB and SES for histological grade LL groupHH groupHL groupLLHgroupp valupTT1a31 (94%)0(0%)2(6%)0(0%)0.001 T1b162(92%)4(2%)1(1%)10(6%) T1c421(79%)43(8%)14(3%)52(10%) T2335(68%)63(13%)10(2%)82(17%) T352(68%)8(10%)2(3%)15(19%) T425(71%)4(11%)0(0%)6(17%) pNnegtive668(78%)73(9%)13(2%)101(12%)0.08 positive358(74%)49(10%)16(3%)64(13%) lynegative600(79%)6(4(8%)14(2%)85(11%)0.18 positive426(74%)58(10%)15(3%)80(14%) vnegative799(80%)81(5%)23(2%)98(10%)0.001 positive227(67%)41(12%)6(2%)67(20%) ER/PgRmegative82(33%)83(33%)13(5%)72(29%)0.001 positive944(86%)39(4%)16(1%)93(9%) HER2negative932(80%)86(7%)22(2%)121(10%)0.001 positive94(52%)36(20%)7(4%)44(24%) CNB;core needle biopsy, SES;surgical excision specimen, HH group (high grade in CNB/high grade in SES), LL group (low grade in CNB/low grade in SES), HL group (high grade in CNB/low grade in SES) and LH group (low grade in CNB/high grade in SES) . The concordance rates of HG of luminal type, HER2 type luminal HER2 type and Triple negative type in CNB and SES were 91%, 64%, 73% and 66%, respectively (p&amp;gt;0.001). Factors of discrepancy were T size, vessel invasion and ER/HER2 status for HG. The discrepancy factors were assessed with univariate and multivariate analysis. The underestimate and overestimate rates of HG in CNB compared to SES were7.5% and 1.3% in ER(+)HER2(-) type, 32%, and 3.1% in HER2 type, 22% and 4.3% in ER(+) HER2(+) type and 29% and 5.5% in Triple negative type(TN), respectively. The concordance rates of tubule formation, nuclear pleomorphism and mitotic index in CNB and SES were 81%, 97% and 93% in luminal type, 85%, 66% and 33% in HER2 type, 77%, 87% and 83% in luminal HER2 type and 82%, 67% and 73% in TN type respectively. Conclusions: Using the largest known dataset to date of paired samples from a single institution, we evaluated the accuracy of CNB and the discrepancy factors between CNB and SES in breast cancer patients. We conclude that CNB for histological grade assessment in patients with HER2 positive or TN breast cancer before neoadjuvant treatment should be used with caution. Citation Format: Nakamura R, Yamamoto N, Miyaki T, Teranaka R, Itami M. Impact of prognoses on the discrepancies in histological grade of breast cancer between core needle biopsy and surgical excision specimen [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-02-01.

Interobserver variation in the diagnosis of fibroepithelial lesions of the breast: a multicentre audit by digital pathology

AimFibroepithelial lesions (FELs) of the breast span a morphological continuum including lesions where distinction between cellular fibroadenoma (FA) and benign phyllodes tumour (PT) is difficult. The distinction is clinically important...

Accuracy and effectiveness of ultrasound-guided core-needle biopsy in the diagnosis of focal lesions in the salivary glands.

To review the diagnostic accuracy of ultrasound-guided core-needle biopsy (CNB) in the diagnosis of salivary gland tumours (SGT). Retrospective, institutional review board approved, analysis of the CNB of SGT performed at our centre in 8 years. We used an automatic 18-G spring-loaded device. The final diagnosis was based on surgery in the cases that were operated on, and on clinical evolution and biopsy findings in the rest. Four hundred and nine biopsies were performed in 381 patients (ages, 2-97 years; mean, 55.9). There were two minor complications. Biopsy was diagnostic in 98.3%. There were eight false negatives. The diagnostic values for malignancy were: sensitivity 89.6%, specificity 100%, positive predictive value (PPV) 100% and negative predictive value (NPV) 98%. For the detection of neoplasms were: sensitivity 98.7%, specificity 99%, PPV 99.7% and VPN 96.1%. Accuracy of CNB in SGT is very high, with a very high sensitivity and an absolutely reliable diagnosis of malignancy. Complication rate is very low. It should be considered the technique of choice when a STG is detected. Normal tissue results warrant repeating biopsy. • Ultrasound-guided core-biopsy is the technique of choice in salivary glands nodules • Sensitivity, specificity for detecting neoplasms (which should be resected) are around 99% • Diagnosis of malignancy in core-biopsy is absolutely reliable • A CNB result of "normal tissue", however, warrants repeating the biopsy • Complication rate is very low.

Fibromatosis of the Breast: Diagnostic Accuracy of Core Needle Biopsy.

Fibromatosis of the breast is an uncommon neoplasm with potential for local recurrence. Treatment has traditionally been surgical excision with current trends toward conservative management. Given the option of observation after diagnosis by core needle biopsy (CNB), we sought to evaluate the accuracy of CNB for diagnosing fibromatosis. We identified a total of 31 cases in which fibromatosis had been diagnosed or included in the differential diagnosis on a CNB, an excision, or both. Morphology and immunohistochemical results were reviewed. Aberrant nuclear immunoreactivity for β-catenin and absent staining for CD34 were the most useful studies to diagnose fibromatosis, and one or both were performed in 21 (68%) cases. High molecular weight cytokeratins and p63 were helpful to exclude spindle cell carcinoma. Of 26 cases confirmed as fibromatosis on excision, 22 (85%) were diagnosed as fibromatosis or fibromatosis was favored in the differential diagnosis on CNB. More frequent use of immunohistochemistry would likely have resulted in a greater number of definitive diagnoses. Fibromatosis was rarely mistaken for other nonmalignant stromal lesions, with no cases misdiagnosed as carcinoma. CNB can be an accurate method of diagnosing fibromatosis, allowing observation for a select group of patients.

Diagnosis of nonexophytic nasopharyngeal lesion with endoscopy-guided core needle biopsy after narrow band imaging.

BackgroundDue to the obstruction of the surrounding structures or stiff mucosa, the primary and recurrent nonexophytic nasopharyngeal carcinoma (NE-NPC) patients are difficult to be diagnosed histologically by traditional forceps biopsy.ResultsAll the 15 cases had adequate biopsy for histological diagnosis. There were 5 cases of primary and 7 cases of recurrent NE-NPC, and 3 cases of inflammatory lesion. The histopathological diagnosis was consistent with the follow-up visit. The bleeding quantity during the CNB procedure ranged from 1 to 5 ml (mean 1.93 mL). The pain score during CNB were between 2 and 7 (mean 4.20). There were no serious complications.Materials and MethodsFrom April 2009 to March 2016, after conventional white-light and novel narrow-band imaging, nasal endoscope-guided core needle biopsy (CNB) were performed on 15 cases of nonexophytic nasopharyngeal lesion with a semiautomatic biopsy gun.ConclusionsCNB is able to get adequate biopsy specimens and thus the diagnosis accuracy of CNB is high for NE-NPC. Nasal endoscope-guided CNB is the direct approach with a short distance in the tissue before reaching the tumor. It has the advantages of minimal trauma, short operative time, and no serious complications. It is simple, safe, and worth of application in clinic.

Diagnostic accuracy of core needle biopsy by image guidance and vacuum assistance.

e12081 Background: Half of the women in the US undergoing annual screening mammography over 10 years require at least one additional imaging study. Of these women, 7%-17% undergo biopsies, the majority of which (77%) are benign. We sought to estimate the accuracy of core needle biopsy (CNB) by method of imaging guidance and use of vacuum assistance (VA). Methods: Data were pooled from four registries participating in the Breast Cancer Surveillance Consortium (bcsc-research.org) including facilities that perform both VA and non-VA CNB. Each registry collects data on screening mammography and breast pathology reports linked to their state cancer registries or regional Surveillance, Epidemiology and End Results registry. Sensitivity was defined as the proportion of positive biopsies among all cancers diagnosed within 12 months of biopsy. PPV3 was defined as the percentage of all biopsies performed that were positive for cancer. We estimated the adjusted average population risks/rates by modality using marginal standardization with logistic regression in STATA.Results: : Among the 37,270 CNBs, breast malignancy was found in 9,241 women (28.6%), of which 2,276 (25%) were ductal carcinoma in-situ. Sensitivity was 90.5% (95% CI 82.6-98.4) for non-VA Stereotactic (n = 415), 95.4% (95% CI 94.7-96.1) for VA Stereotactic (n = 18,733), 96.1% (95% CI 95.4-96.7) for non-VA ultrasound (n = 14,803), 95.1% (95% CI 93.7-96.5) for VA Ultrasound (n = 3,271) and 82.3% (95% CI 59.9-104.6) for non-VA MRI (n = 48). PPV3 was 12.2% (95% CI 9.0, 15.3), 17.7% (95% CI 17.2, 18.3), 28.6% (95% CI 27.8-29.4), 32.1% (95% CI 30.4-33.8) and 16.9% (95% CI 5.3, 28.5), respectively. For stereotactic biopsies, VA was associated with improved PPV3 (p = 0.01) without any change in sensitivity compared to non-VA Stereotactic biopsies.Conclusions: Our multicenter data confirm that VA-stereotactic CNB and ultrasound CNB with or without VA have high sensitivity and thus represent effective alternatives to open surgical biopsy.

Diagnostic Yield for Cancer and Diagnostic Accuracy of Computed Tomography-guided Core Needle Biopsy of Subsolid Pulmonary Lesions.

We aimed to determine the diagnostic yield for cancer and diagnostic accuracy of computed tomography-guided core needle biopsy (CTNB) in subsolid pulmonary lesions. Fifty-two biopsies of 52 subsolid lesions in 51 patients were identified from a database of 912 lung biopsies and analyzed for the diagnostic yield for cancer and diagnostic accuracy of core CTNB diagnosis as well as complication rates. When indeterminate biopsy results were included in the analysis, the diagnostic yield for cancer was 80.8% and the diagnostic accuracy of core needle biopsy was 84.6% (n=52). It was 85.7% and 91.7%, respectively, when indeterminate results were excluded (n=48) and 82.4% and 82.4%, respectively, for biopsies with surgical confirmation (n=17). Attenuation was statistically significant for diagnostic yield for cancer (P=0.028) and diagnostic accuracy of core needle biopsy (P=0.001) when the indeterminate results were excluded (n=48). Attenuation and size were not statistically significant for diagnostic yield for cancer and diagnostic accuracy of needle biopsy (n=52), and size was not statistically significant for either when the indeterminate results were excluded. These results were achieved without any major complications as per the Society of Interventional Radiology Standards of Practice. CTNB offers a high yield in establishing a histopathologic diagnosis of subsolid pulmonary lesions, with both ground-glass and solid-predominance. The pure ground-glass category of lesions requires further research to determine the true diagnostic yield and diagnostic accuracy of core needle biopsies.

Comparison of Core Needle Biopsy and Surgical Specimens in Determining Intrinsic Biological Subtypes of Breast Cancer with Immunohistochemistry.

PurposeWe evaluated the concordance between core needle biopsy (CNB) and surgical specimens on examining intrinsic biological subtypes and receptor status, and determined the accuracy of CNB as a basic diagnostic method.MethodsWe analyzed breast cancer patients with paired CNB and surgical specimen samples during 2014. We used monoclonal antibodies for nuclear staining, and estrogen receptor (ER) and progesterone receptor (PR) status evaluation. A positive test was defined as staining greater than or equal to 1% of tumor cells. Human epidermal growth factor receptor 2 (HER2) was graded by immunohistochemistry and scored as 0 to 3+ according to the recommendations of the American Society of Clinical Oncology/College of American Pathologists. Ki-67 immunostaining was performed using the monoclonal antibody Ki-67, and the results were divided at 10% intervals. The cutoff value for high Ki-67 was defined as 20%. Concordance analysis of ER, PR, HER2, Ki-67, and five intrinsic biological subtypes was performed on CNB and surgical specimens. Statistical analysis for concordance was calculated using κ-tests.ResultsWe found very good agreement for ER and PR with a concordance of 96.7% for ER (κ=0.903), and 94.3% for PR (κ=0.870). HER2 and Ki-67 showed concordance rates of 84.8% (κ=0.684) and 83.5% (κ=0.647), respectively, which were interpreted as good agreement. Five subgroups analysis showed 85.8% agreement and κ-value of 0.786, also indicating good agreement.ConclusionCNB showed high diagnostic accuracy compared with surgical specimens, and good agreement for ER, PR, HER2, and Ki-67. Our findings reaffirmed the recommendation of CNB as an initial procedure for breast cancer diagnosis, and the assessment of receptor status and intrinsic biological subtypes to determine further treatment plans.

Diagnostic performance of core needle biopsy in identifying breast phyllodes tumors.

A retrospective analysis of diagnoses was performed in patients with phyllodes tumors of the breast (PTB) who received preoperative core needle biopsy (CNB) and had breast surgery at Fudan University Shanghai Cancer Center from January 1, 2002 to April 1, 2013. The resulting data allowed us to compare the accordance between CNB and excision diagnoses of PTB patients and evaluate the accuracy of CNB in preoperative diagnosis. Data from 128 patients with PTB who had undergone preoperative CNB and breast surgery were retrospectively analyzed. We reviewed the medical history, clinical follow-up data, and CNB diagnostic data. A diagnostic test was used to evaluate the sensitivity and specificity of CNB in diagnosing benign, borderline, and malignant phyllodes tumors. The accuracy of CNB for diagnosing PTB was 13.3% (17/128). Of the remaining patients, 98 (75.5% of the PTB patients) were diagnosed with fibroadenoma or fibroepithelial lesions. The sensitivity of CNB at diagnosing benign, borderline, and malignant phyllodes tumors were 4.9% (2/41), 4.2% (3/71), and 25.0% (4/16), respectively, whereas the corresponding specificity were 92.0%, 98.2%, and 100%, respectively. Some clinical features, such as large tumor size, rapid growth, or surgical history of fibroadenomas, were indicative of an increased possibility of PTB. CNB provides a pathological basis for the preoperative diagnosis of PTB, but it has a poor accuracy and offers limited guidance for surgical decisions. Considering CNB along with multiple histologic features may improve the ability to accurately diagnose PTB. An integrated assessment using CNBs in combination with clinical data and imaging features is suggested as a reliable strategy to assist PTB diagnosis.

Accuracy of Core Needle Biopsy for Musculoskeletal Lesion in Cipto Mangunkusumo Hospital Jakarta

Core needle biopsy (CNB) is considered to have similar results with open biopsy in accuracy and already becomes a routine procedure to establish the diagnosis of musculoskeletal lesion. However, the accuracy of CNB for muskuloskeletal lesion in Indonesia has not been reported. The aims of the study to know the accuracy of CNB for muskuloskeletal tumor diagnoses. From January 2011 to August 2015, all patients with musculoskeletal lesion in dr. Cipto Mangunkusumo Hospital underwent CNB and subsequently, tumour excision were indentified and enrolled. Diagnostic accuracy was evaluated for both histopathology and clinicopathological conference (CPC) conclusion. A total of 86 samples were enrolled in this study. The accuracy of CNB compared to post excision histopathology is 74.4%. With CPC conclusion, the accuracy is 83.7% with sensitivity 98%, specificity 59% (p<0.001). The accuracy of CNB after immunohistochemistry was increased from 74.4% to 84.9% with sensitivity 98%. The accuracy of CNB was 97.1% and 82.7% for benign lesion and malignant lesion respectively (p<0.01). The accuracy of CNB to differ and to confirm diagnosis as primary or metastatic lesion was 97.2% and 85.7% respectively (p<0.001). Inconclusion, CNB is a reliable diagnostic method to establish musculoskeletal tumor diagnoses. CPC significantly provides better accuracy rate of CNB.

The Role of Core-Needle Biopsy for Thyroid Nodules with Initially Nondiagnostic Fine-Needle Aspiration Results: A Systematic Review and Meta-Analysis

This study evaluated the prevalence of nondiagnostic results, diagnostic performance, and complications of core-needle biopsy (CNB) compared with repeat fine-needle aspiration (FNA) for thyroid nodules with previous nondiagnostic FNA findings. The Ovid-MEDLINE and EMBASE databases were thoroughly searched for studies evaluating CNB or repeat FNA for thyroid nodules with initially nondiagnostic FNA results. Pooled proportions of nondiagnostic results of CNB and repeat FNA were calculated. A meta-analysis was performed to evaluate the diagnostic accuracy of CNB and repeat FNA for a diagnosis of malignancy using a bivariate random-effects model. Complication rates were also evaluated. A review of 52 articles identified 4 eligible articles, involving 1,028 patients with 1,028 thyroid nodules, which were included in the meta-analysis. CNB demonstrated significantly lower rates of nondiagnostic results (6.4%) than repeat FNA (36.5%) (P<.0001). In the 3 studies that analyzed the diagnostic accuracy of CNB in diagnosing malignancy, CNB demonstrated significantly higher summary estimates of sensitivity (89.8%) than repeat FNA (60.6%) (P = .022), but summary specificity did not differ between CNB (99.2%) and repeat FNA (99.0%) (P = .576). None of the patients who underwent CNB or repeat FNA experienced any major complications. CNB demonstrates lower rates of nondiagnostic results and higher diagnostic accuracy than repeat FNA. CNB, rather than repeat FNA, can be utilized to diagnose thyroid nodules previously nondiagnostic on FNA. CI = confidence interval CNB = core-needle biopsy FNA = fine-needle aspiration SROC = summary receiver operating characteristic US = ultrasound.

CT-guided percutaneous core-needle biopsy of pancreatic masses: comparison of the standard mesenteric/retroperitoneal versus the trans-organ approaches

To compare the safety and efficacy of percutaneous computed tomography (CT)-guided core-needle biopsy (CNB) of pancreatic masses traversing the gastrointestinal tract or solid viscera versus trans-mesenteric and retroperitoneal approaches. CT-guided CNB of pancreatic lesions performed between May 2004 and December 2014 were retrospectively analysed at a single centre. Biopsies were performed using 18- or 20-G needles with a coaxial system. CT images, histopathology reports, medical records, and procedural details for all patients were reviewed to evaluate the biopsy route, complications, and diagnostic accuracy. According to the routes, biopsies were divided into trans-mesenteric, retroperitoneal and trans-organ approaches for comparison. A total of 85 patients, who had undergone 89 CNBs for pancreatic masses were reviewed. The overall sensitivity, specificity, and accuracy of CNB for detecting malignancy via various routes were 88.8%, 100%, and 89.9%, respectively, with a complication rate of 20.2%. Trans-organ biopsies of pancreatic masses (n=22) were performed safely via a direct pathway traversing the stomach (n=14), colon (n=3), small bowel (n=2), liver (n=2), and spleen (n=1). The sensitivity, specificity, and accuracy were 90.5%, 100%, and 90.9%, respectively. In the trans-organ biopsy group, three biopsies (13.6%) resulted in minor haematomas, but no major complications occurred. There were no statistically significant differences in the diagnostic efficacy or complication rate among the different biopsy routes. Percutaneous CT-guided CNB using a trans-organ approach is a feasible technique for diagnosing pancreatic malignancy; however, as this series was small, more data is required.

High diagnostic accuracy of core needle biopsy of soft tissue tumors: An institutional experience.

Core needle biopsy (CNB) has been suboptimal in the subclassification and grading of mesenchymal tumors. Recent advances in molecular diagnostics have shown promise in improving this area. The institutional experience with CNBs of soft tissue lesions on cytology cases and correlated histologic follow-up has been evaluated. It also addressed the advantageous use of ancillary techniques, including immunohistochemistry and molecular studies. Archived cytologic CNB material and reports of patients with soft tissue lesions were retrieved and CNB results with final resection results were compared. Cases were re-reviewed and data were analyzed with descriptive statistics. From archived data, 215 cases were extracted of 99 female and 116 male patients (mean [range] age, 59.9 [12-95] years). Categories were malignant (n = 157), suspicious (n = 16), and benign (n = 42). In total, 161 (74.9%) had subsequent surgical resection-130 were malignant; 8, suspicious; and 23, benign. Of the malignant or suspicious cases, 138 had follow-up histologic resections, with 97.9% concordance. The most common malignant tumor was liposarcoma (n = 41; 29.7%), followed by undifferentiated pleomorphic sarcoma (30; 21.7%). Of benign tumors, 23 (54.8%) had follow-up surgical resection. Low-grade gastrointestinal stromal tumor was the most common benign tumor (26.1%), followed by fibromatosis (21.7%). Cytohistologic correlation for all categories showed 96.9% concordance. Molecular ancillary studies correctly classified malignant tumors in 37 (26.8%) of the 138 cases. CNB is a reliable modality for evaluating soft tissue neoplasms, with high histologic concordance rate.