Additional Tissue Sampling Research Articles

Retained Biopsy Site Markers After Breast Lesion Surgical Resection: Associations With Residual Malignancy.

BACKGROUND. Biopsy site markers (BSMs) placed during image-guided core needle biopsy (CNB) are typically targeted for surgical excision, along with the breast imaging abnormality. Retained BSMs raise concern of incomplete resection of the breast abnormality. OBJECTIVE. The purpose of our study was to assess the frequency of residual malignancy in patients with retained BSMs identified on the initial mammography performed after breast lesion surgical excision. METHODS. This retrospective study included 30 patients (median age, 59 years) who underwent surgical resection between August 2015 and April 2022 of a borderline, high-risk, or malignant breast lesion after CNB and technically adequate preoperative image-guided localization, in whom the initial postoperative mammography report described a retained nonmigrated BSM. EMR data were extracted. The index pathology from CNB and initial surgical resection was classified as malignant or nonmalignant. The presence of residual malignancy after initial surgical resection required pathologic confirmation from subsequent tissue sampling; the absence of residual malignancy required 2 years of benign imaging follow-up. RESULTS. Thirteen specimen radiographs were interpreted intraoperatively by a surgeon with later radiologist interpretation, and 17 underwent real-time radiologist interpretation. Eighteen patients had malignant index pathology from the initially resected lesion. The frequency of residual malignancy on subsequent follow-up after initial surgical resection was higher in patients with malignant than nonmalignant index pathology (39% [7/18] vs 0% [0/12], respectively; p = .02). Among patients with malignant index pathology, the frequency of residual malignancy was higher in those without, than with, malignancy in the initial surgical specimen (80% [4/5] vs 23% [3/13]; p = .047). Also in these patients, the frequency of a positive interpretation of the initial postoperative mammography (BI-RADS category 4 or 6) was not significantly different between those with and without residual malignancy (57% [4/7] vs 55% [6/11]; p > .99). CONCLUSION. Patients with retained BSMs associated with malignant index lesions are at substantial risk of having residual malignancy. Initial postoperative mammography is not sufficient for excluding residual malignancy. CLINICAL IMPACT. Retained BSMs associated with index malignancy should be considered suspicious for residual malignancy. In this scenario, timely additional tissue sampling targeting the retained BSM is warranted, given the greater-than-2% chance of malignancy. Active surveillance is a reasonable management strategy in patients with retained BSMs from nonmalignant index lesions.

P11.18.B AIMING TOWARDS DIFFERENTIATING GLIOBLASTOMA PROGRESSION FROM PSEUDO PROGRESSION -PATIENTS COHORT ESTABLISHMENT AND PRELIMINARY RESULTS

Abstract BACKGROUND Longitudinal follow-up of glioblastoma patients includes advanced imaging modalities to identify tumor progression, which is of limited certainty and occasionally necessitates additional tissue sampling that has potential morbidity. Lately, the possibility of tumor-associated protein markers detection in patients' blood samples - liquid biopsies - has shown useful for this purpose in other cancers and has also gained significant interest in glioblastoma. METHODS This study presents data collected from 36histopathology-confirmed IDH-WT glioblastoma patientstreated in Sheba Medical Center between the years 2009 to 2021. Following their diagnosis, these patients were treated with radiation according to the Stupp protocol and subjected to repeated resection due to suspected tumor progressionbased on imaging studies. The data retrieved from patients' medical files include demographics, clinical outcomes, imaging characteristics, tumor molecular, andhistopathological markers. Notably, patients' selection and data retrieval were accomplished using a novel institutional AI algorithm software followed by complementary manual data retrieval of selected patients' medical files. RESULTS Patients demographics analysis showed that patientmedian age-at-diagnosis was 55.4 years (range, 21-82), and the male-to-female ratio was 3.5:1. The median overall survival (OS) was 25.1 months (range, 5.2-80.3) and the median follow-up duration was 23.1 months (range, 4.8-80.2).27 out of 36 patients had pathologically confirmed tumor progression while the remaining patients had post-radiation changes along with viable tumor or merely radiation necrosis identification. Pre-surgical resection blood samples were available for 27 out of 37 patients and will be used for a comprehensive glioblastoma-related proteins search using mass spectroscopy. In cases of patients' blood samples available both from the initial diagnosis surgical resection procedure and tumor progression surgical resection, a comparative analysis of those samples will be performed. The preliminary proteomics analysis and clinical outcomes measurements and volumetric tumor data will be presented. CONCLUSION s: Here, we present a glioblastoma patient cohort that was meticulously selected with the aim to examine our hypothesis that measuring glioblastoma-related proteins in patients' blood can be achieved and serve as a tool to distinguish between disease phases and monitor disease progression. Our comprehensive preliminary clinical, as well as proteomics data analysis, will be presented and discussed.

Favorable Conditions for the Detection of EGFR T790M Mutation Using Plasma Sample in Patients with Non-Small-Cell Lung Cancer.

Detection of the epidermal growth factor receptor (EGFR) T790M mutation using plasma samples has been considered simple and non-invasive, but the relatively high false negative results lead to additional tissue sampling in some patients. Until now, the characteristics of patients who prefer liquid biopsy have not yet been established. To evaluate the favorable conditions for the detection of T790M mutations using plasma samples, a multicenter retrospective study was performed between May 2018 and December 2021. Patients whose T790M mutation was detected in a plasma sample were classified as the plasma positive group. Study subjects with a T790M mutation not detected in a plasma sample but only in a tissue sample were grouped as the plasma false negative group. Plasma positive and plasma false negative groups were found in 74 and 32 patients, respectively. As a result, 40% of patients with one or two metastatic organs at the time of re-biopsy had false negative plasma sample results, and 69% of patients with three or more metastatic organs at the time of re-biopsy had positive plasma results. In multivariate analysis, three or more metastatic organs at initial diagnosis were independently associated with the detection of a T790M mutation using plasma samples. Our results demonstrated that the detection rate of a T790M mutation using plasma samples was related to the tumor burden, particularly to the number of metastatic organs.

S3695 Collagenous Gastritis: A Rare Cause of Severe Iron Deficiency Anemia in a Basic Military Trainee

Introduction: Collagenous gastritis is a rare inflammatory disease characterized by deposition of a thick subepithelial band of collagen and associated inflammatory infiltrate. This disorder has a reported prevalence of 13 per 100,000 esophagogastroduodenoscopies (EGDs) with a female predominance. Two distinct clinical phenotypes have been described: adult-onset characterized by diffuse gastrointestinal involvement and diarrhea, and pediatric-onset manifesting with abdominal pain and anemia. We present an interesting case of pediatric-phenotype collagenous gastritis to highlight this poorly-recognized disorder. Case Description/Methods: A 19-year-old male basic military trainee was referred for evaluation of incidentally discovered iron deficiency anemia. He denied any symptoms, overt blood loss, or NSAIDs. Physical exam was unremarkable. Labs revealed hemoglobin of 9.3 g/dL, iron saturation 7% and ferritin 15 ng/mL. The patient underwent EGD and colonoscopy for further evaluation. EGD revealed a diffusely nodular appearance of the gastric mucosa with areas with suspected atrophy under narrow-band imaging (Figures 1A, B). Colonoscopy was normal. Biopsies returned with a non-specific chronic gastritis without H. pylori. Abdominal computed tomography and additional work up for autoimmune gastritis, fecal H. pylori antigen, syphilis, and heavy metals toxins were all normal. Decision was made to repeat EGD for additional tissue sampling, including cold snared samples. Repeat gastric biopsies with expert GI pathologist review revealed collagenous gastritis, characterized by subepithelial deposition of a thick (greater than 10 µm) collagen band and associated inflammatory infiltrate (Figures 1C, D). Patient was lost to follow up due to disqualification for military service. Discussion: Collagenous gastritis is an exceedingly rare heterogeneous disease process of poorly understood causes and pathogenesis, with autoimmune conditions, medication effects, and infections theorized to be responsible. Numerous treatments have been reported with variable effect, including antisecretory agents, corticosteroids, immunomodulators, and hypoallergenic diets, along with micronutrient supplementation. Due to its rarity, a high level of suspicion is required by gastroenterologists and pathologists based on clinical and endoscopic findings. Our case helps to bring awareness to collagenous gastritis, and emphasizes the potential value for repeat tissue sampling with expert pathologist review.Figure 1.: A: Diffusely nodular appearance of the gastric mucosa with areas. B: Narrow-band imaging reveals areas of suspected atrophy. C: Multiple fragments of gastric mucosa with a prominent lymphoplasmacytic infiltrate within the lamina propria and occasional foci of subepithelial collagen deposition (red arrows). [Hematoxylin & Eosin, 50× magnification]. D: On higher magnification a focus of subepithelial collagen deposition may be seen associated with epithelial injury indicated by loss of foveolar mucin and detachment of the surface epithelium. [Hematoxylin & Eosin, 200× magnification].

ENDOBRONCHIAL ULTRASOUND-GUIDED INTRALESIONAL CRYOBIOPSY: A CASE SERIES

ENDOBRONCHIAL ULTRASOUND-GUIDED INTRALESIONAL CRYOBIOPSY: A CASE SERIES

Validating cell-free DNA from supernatant for molecular diagnostics on cytology specimens.

Cytology specimens are often used for biomarker testing in the setting of neoplasia. On occasion, formalin-fixed paraffin-embedded (FFPE) cell blocks unfortunately may not yield sufficient material for testing. Recent studies have suggested that residual supernatant fluid from cell block preparation is a valuable source of DNA: both cellular and cell-free DNA (cfDNA). In the present study, the use of cfDNA from supernatant is compared against DNA from FFPE materials. cfDNA was extracted prospectively fromresidual supernatants of 30 cytologysamples (29 neoplastic cases and 1 benign ascitic fluid from a patient with a history of melanoma).Samplesweretested using clinically validated next-generation-sequencing platforms and the results werecompared with data from paired FFPEcell blocks in a real-time prospective clinical setting. Thirteen samples were tested on an amplicon-based assay (Solid Tumor Hotspot), and 17 samples were tested using a comprehensive capture-based assay (UW-Oncoplex). Neoplastic content was estimated by mutational variant allele fraction, with a mean content of 24.0% and 25.8% in supernatant and FFPE, respectively. The variant concordance between paired samples was 90%, and identical results were detected in both supernatant and FFPE samples in 74% of cases. This study confirmed that cfDNA from supernatant is a viable alternativeto FFPE cell blocksfor molecular biomarker testing using both amplicon-based and capture-based assays with potential for decreasing additional tissue sampling and faster turnaround time.

Additional Tissue Sampling Trials Did Not Change Our Thyroid Practice.

Simple SummarySome studies have suggested that the use of additional tissue blocks to diagnose follicular thyroid carcinoma (FTC) could increase the accuracy of diagnosis and improve prognosis, and entire capsule sampling was recommended for a definitive diagnosis of borderline thyroid tumors in 2016. We conducted a study in 2016 to examine whether additional tissue sampling of the encapsulated follicular tumor increases the diagnosis of malignant cases in our patient cohort. Furthermore, the diagnosis was reclassified according to the 4th edition of the World Health Organization’s classification system. The additional tissue sampling only had a slight impact on our thyroid practice and resulted in no benefits to the patient; therefore, we decided to cease it.This study aimed to determine whether additional tissue sampling of encapsulated thyroid nodules would increase the frequency of follicular thyroid carcinoma (FTC) diagnoses. We examined thyroid tissue specimens from 86 patients suspected of FTC (84.9% female; mean age, 49.0 ± 17.8 years). The number of tissue blocks created for pathological assessments ranged from 3 to 20 (mean, 9.1 ± 4.1); the numbers in the previous method recommended by the Japanese General Rules for the Description of Thyroid Cancer and additional blocks ranged from 1 to 12 (mean, 6.0 ± 2.8) and from 1 to 8 (mean, 3.1 ± 2.0), respectively. The additional blocks were subsequently examined to determine whether any diagnoses changed from those based on the previous method. Five patients were diagnosed with FTC using the previous method; however, additional tissue blocks led to the diagnosis of FTC in 6 patients, as 1 diagnosis was revised from follicular adenoma to FTC. It has been reported that increasing the number of tissue blocks used for pathological assessments can increase the frequency of FTC diagnoses; however, this was not clinically significant in thyroid carcinoma, which requires completion thyroidectomy and radioactive iodine treatment. It resulted in no benefits to the patient because all minimally invasive FTCs, follicular tumors of uncertain malignant potential (FT-UMP), and follicular adenomas are treated with lobectomy alone in Japan. Additional tissue sampling only had a slight impact on our thyroid practice; therefore, we decided to cease it.

Abstract PS5-37: The feasibility of obtaining oncotype DX breast recurrence score® results from metastatic sites of patients with hormone receptor positive metastatic breast cancer

Abstract Background: Identifying when to start CDK4/6 inhibitors or use chemotherapy in hormone receptor positive (HR+) metastatic breast cancer (MBC) remains challenging. The 21-gene Oncotype DX Breast Recurrence Score® test is validated to predict chemotherapy benefit in early stage HR+ breast cancer but has not been studied for use in the MBC setting.Objective: To assess the feasibility of obtaining Recurrence Scores from metastatic sites after standard of care biopsy in HR+, HER2 negative patients and correlate Recurrence Score results from matched primary breast cancer when available. Methods: A total of 48 metastatic biopsies were retrieved retrospectively from the residual tissue of patients with primary HR+, HER2 negative breast cancer. This included 36 from bone and 12 from other sites [liver (7), lung (1), rectum (1), brain (1), skin (2)]. Slides were sent to Genomic Health Inc. for RNA isolation and Recurrence Score result determination using standardized protocols. Recurrence Score results were available for 18 matched primary and metastatic biopsy samples. The percent success rate for Recurrence Score result was determined for the various metastatic sites and results compared between matched primary and metastatic site. Results: Recurrence Score results were obtained in 48% of metastatic biopsies (23 of 48 samples) including bone (17), liver (4), lung (1), and skin (1). Reasons for Recurrence Score failure included insufficient RNA (17), poor quality RNA (1), failed QC (4), and other (3). The mean Recurrence Score from the 23 metastatic sites was 35 (range: 1–66). Notably, 70% (16/23) of successful metastatic biopsies yielded Recurrence Scores in the high-risk range (>25). None of the 23 metastatic biopsies gained HER2 by RT-PCR. Among the 18 paired samples, higher recurrence score results were observed in all but three of the metastatic biopsy samples with mean Recurrence Score results of 20 (range 7 to 41) for the primary and 35 (range 1-66) for the metastatic site. For paired samples, 72% of metastatic biopsies yielded Recurrence Scores >25 compared to 17% of primary sample. Primary Recurrence Scores were not predictive of metastatic scores (r2=0.052). Estrogen receptor (ER) expression status was conserved in 87% whereas progesterone receptor (PR) was lost in 69% of the metastatic lesion. Among the pairs, 5 had de novo metastatic disease. In these, the Recurrence Score was higher in the metastatic biopsy in each case compared to the matched primary (mean 36 versus 23, respectively). Among de novo cases, there was 100% concordance in ER positive and HER2 negative expression and only 60% concordance in PR expression between primary and metastatic sites. Conclusion: Using standard of care metastatic biopsy samples, a Recurrence Score result was successfully generated in 48% of samples including bone. This small series demonstrates wide variability in Recurrence Score results in metastatic disease with overall higher scores, common loss of PR, and minimal correlation to matched primary disease. Further examination of the potential significance of the Recurrence Score for treatment decisions in the metastatic setting requires additional tissue sampling during biopsy as insufficient RNA was the primary reason for failure. Citation Format: Julie Anne L Gemmill, Patricia Thompson, Rebecca Batiste, Caterina Vacchi-Suzzi, Christina Preece, Jules Cohen, Lea Baer, Carolyn Mies, Michelle Turner, Christy A Russell, Alison Stopeck. The feasibility of obtaining oncotype DX breast recurrence score® results from metastatic sites of patients with hormone receptor positive metastatic breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS5-37.

Usefulness of Additional Tissue Sampling in Lung Specimens

Usefulness of Additional Tissue Sampling in Lung Specimens

The Role of Endoscopic Ultrasound in the Diagnostic Assessment of Subepithelial Lesions of the Upper Gastrointestinal Tract

IntroductionThe identification of subepithelial lesions is a relatively frequent finding at endoscopy however their natural history is not well known. Our aim was to analyze the role of endoscopic ultrasound (EUS) in the diagnostic approach of subepithelial lesions of the upper gastrointestinal tract. MethodsRetrospective study which included 324 patients undergoing upper radial EUS for evaluation of subepithelial lesions from 2008 to 2014. The EUS features, presumptive diagnosis and management decision were analyzed. Results324 patients included, 60% with gastric subepithelial lesions, 28% oesophageal and 12% from the duodenum. Based on EUS features the presumptive diagnosis was: 25% gastrointestinal stromal tumor, 21% lipoma, 19% leiomyoma, 17% pancreatic rest, 7% submucosa cysts, 1% granular cell tumors, 1% carcinoids, 1% mucosa lesions and 8% not defined. After EUS the suggested approach was no follow-up in 45%, follow-up with re-examination with EUS in 35% and additional tissue sampling or endoscopic/surgical resection in 20%. The latter was based on EUS features of risk at the diagnosis (53%), such as size ≥2cm, hypoechogenicity, heterogeneity, lobulation, calcifications, cystic component and regional adenopathies; impossibility to define a presumptive diagnosis (39%) or EUS features change at follow-up (8%). The combination of multiple features correlated with a higher probability of this recommended strategy (p<0.001), in 100% when 4 or more features were present. Among the 33 patients who underwent fine needle aspiration, in 66% the result was inconclusive. During follow-up, none of the patients who were managed with surveillance radial EUS presented complications. ConclusionEUS is the method of choice in the study of subepithelial lesions of the upper gastrointestinal tract, in most cases defining a diagnosis. The need for a definitive diagnosis or therapeutic approaches can be based on ultrasound risk features, presented, in the majority, at presentation. This study shows that EUS is capable of safely and accurately define those subepithelial lesions that can be managed only with surveillance ultrasound while waiting for better results with fine needle aspiration.

Poorly Differentiated Thyroid Carcinoma Arising in Struma Ovarii.

Struma ovarii is an uncommon type of ovarian mature teratoma with a predominant thyroid component. The morphological spectrum of the thyroid tissue ranges from that of normal thyroid to proliferative adenoma-like lesions and thyroid-type carcinomas (malignant transformation). The histologic features of ovarian strumal lesions sometimes cause diagnostic problems due to the confusion with other types of ovarian neoplasms and the difficulty in the prediction of their clinical behavior. We report an extremely rare case of poorly differentiated thyroid carcinoma arising in struma ovarii. A 22-year-old woman presented with a 15 cm right ovarian mass. The tumor showed a predominantly tubular pattern which raised a differential diagnosis between endometrioid adenocarcinoma and Sertoli cell tumor. A review of the gross specimen with additional tissue sampling helped identify the teratomatous and strumal nature, with a support by immunohistochemical staining. Despite FIGO stage IA by optimal staging procedure and the absence of identifiable lymphovascular invasion, the patient developed pulmonary metastasis 15 months after surgery and died from the progression of the disease 7 years after the diagnosis. This case emphasizes the importance of macroscopic examination of the specimen and the awareness of this uncommon tumor in the differential diagnosis of ovarian neoplasms.

The Addition of Internists to a Breast Health Program

With the increases in complexity of care for breast health concerns, there is a growing need for efficient and effective clinical evaluation, especially for vulnerable populations at risk for poor outcomes. The Breast Health Center at Boston Medical Center is a multidisciplinary program, with internists providing care alongside breast surgeons, radiologists, and patient navigators. Using a triage system previously shown to have high provider and patient satisfaction, and the ability to provide timely care, patients are assigned to either a breast surgeon or internist. From 2007 to 2009, internists cared for 2,408 women, representing half of all referrals. Women served were diverse in terms of race (33% black, 30% Hispanic, 5% Asian), language (34% require language interpreter), and insurance status (51% had no insurance or public insurance). Most presented with an abnormal screen (breast examination 54% or imaging 4%) while the remainder were seen for symptoms such as pain (26%), non-bloody nipple discharge (4%), or risk assessment (7%). A majority of final diagnoses were made through clinical evaluation alone (n = 1,760, 73%), without the need for additional diagnostic imaging or tissue sampling; 9% (n = 214) received a benign diagnosis with the aid of breast imaging; 19% (n = 463) required tissue sampling. Only 4% went on to see a breast surgeon. Internists diagnosed 15 incident cancers with a median time to diagnosis of 19 days. Patient and provider satisfaction was high. These data suggest that a group of appropriately trained internists can provide quality breast care to a vulnerable population in a multidisciplinary setting. Replication of this model requires the availability of more clinical training programs for non-surgical providers.

Simultaneous occurrence of malignant fibrous histiocytoma and hepatocellular carcinoma in cirrhotic liver: A case report

Primary hepatic malignant fibrous histiocytoma (MFH) is rarely encountered. There have been no reports to date of hepatic MFH associated with liver cirrhosis. The presence of liver cirrhosis is considered an adjunctive feature favoring sarcomatoid hepatocellular carcinoma (HCC) in the diagnosis of spindle cell tumors in liver. We describe here a 59-year-old man with liver cirrhosis due to hepatitis B virus infection 20 years ago. On abdominal computed tomography scanning, two distinct hepatic masses were identified in the background of cirrhosis, which had different radiological features from conventional HCC. He underwent segmentectomy for removal of the tumors. The pathological examination of surgically resected specimen revealed the large malignant spindle cell tumor and small conventional HCC. Additional tissue sampling and immunohistochemical stainings demonstrated that the spindle cell tumor was consistent with MFH. On the post-operative follow-up for 21 mo, a round mass showing similar radiological findings for the previous MFH was appeared on the surface of resection margin, suggesting the recurrence. Despite its rarity, hepatic MFH should be considered during differential diagnosis, even in cirrhotic patients, and extensive tissue sampling and immunohistochemical analyses are necessary in the diagnosis of hepatic spindle cell tumors.

Encapsulated Classic and Follicular Variants of Papillary Thyroid Carcinoma: Comparative Clinicopathologic Study

To compare the clinicopathologic features of papillary thyroid carcinoma classic variant (PTC-CV) and papillary thyroid carcinoma follicular variant (PTCFV), with a focus on the encapsulated form. In a retrospective search of computerized pathology files for 1996 to 1998, a cohort of 114 cases (58 cases of PTC-CV and 56 cases of PTC-FV) were selected for this study. Clinicopathologic data and long-term follow-up (serum thyroglobulin measurements, radiologic studies, and additional tissue sampling) through the date of compilation of study data were extracted from the medical records. The median patient age at initial diagnosis was 46 years for the PTC-CV group and 45.5 years for the PTC-FV group. Complete tumor encapsulation was seen in 40 PTC-CV cases (69%) and in all PTC-FV cases (100%). A higher rate of tumor capsule invasion (CI), lymphovascular invasion (LVI), extrathyroidal extension, and lymph node metastatic lesions was seen in PTC-CV than in PTC-FV: CI, 26% versus 18%; LVI, 17% versus 4%; extrathyroidal extension, 19% versus 7%; and lymph node metastatic lesions, 68% versus 29%. Clinical, radiologic, or pathologic follow-up data were available in 36 PTC-CV cases (62%) and 34 PTC-FV cases (61%). The median duration of follow-up for the PTC-CV group was 10 years and for the PTC-FV group was 9 years. Tumor recurrence was found in 10 patients with PTC-CV (28%) and 2 with PTC-FV (6%). Distant metastatic lesions occurred in 3 patients with PTC-CV (8%) and 1 patient with PTC-FV (3%) (P = .17); of these, 2 cases of PTC-CV were encapsulated and showed CI, LVI, and lymph node metastatic lesions. Our current study confirms previous reports that both encapsulated PTC-CV and encapsulated PTC-FV are indolent tumors and are associated with very low mortality.

Limiting the Use of Atypical/Inconclusive as a Category in Nongynecologic Cytology Specimens

'Atypical' has served as a descriptive term in cytology since the birth of the specialty by Dr Papanicolaou. This indeterminate diagnosis often results in repeat biopsies or additional tissue sampling and a needless delay in patient care if used inappropriately. Because of the definitional ambiguity of this term and the associated physician frustration, we have made a concerted effort at Methodist Hospital since 1995 to minimize the use of 'atypical' as a diagnostic category. To evaluate whether the dissolution of the 'atypical' category has increased our cytologic-histologic discordance rate to more than the published reference range. From March 3, 2006, through December 31, 2008, all nongynecologic cases with 'atypical/indeterminate' listed as the general diagnostic category were identified and retrieved from our laboratory data files. We then assessed the cytologic-histologic correlation rate during the corresponding time frame. A total of 48 'atypical' cases (0.2%) from 19 347 nongynecologic specimens were identified. Of the 'atypical' cases, 52% (25 of 48) had intradepartmental consultation, 58% (28 of 48) had additional preparations examined, and 29% (14 of 48) documented limitations because of poor preservation. Our cytologic-histologic discrepancy rate for the period was 5.5% (214 of 3912 cases), with 89.3% (191 of 214 cases) resulting from sampling issues. On review of the small percentage of cytologic interpretative discrepancies, only one case was unhampered by less than 10% tumor cellularity or poor preservation. Not using 'atypical' as a diagnostic category, unless defined by Bethesda guidelines, has not affected our cytologic-histologic correlation rate.

MRI Detection of Otherwise Occult Malignancies in Women Recently Diagnosed with Breast Cancer.

Abstract Objective. Breast Magnetic Resonance Imaging (MRI) is recommended as a screening test for women at high risk for breast cancer but its role as a diagnostic tool for women recently diagnosed with breast cancer is not universally accepted. We report outcomes in a center that routinely uses breast MRI to evaluate extent of disease in patients recently diagnosed with breast cancer.Material and Methods. Between 1/1/2003 and 4/30/2007, 592 patients with recently diagnosed breast cancer underwent bilateral breast MRI to assess extent of disease. All had undergone mammography prior to breast MRI. Twenty-two were excluded because they were either lost to follow up (n=7) or had a mastectomy or lumpectomy (n=15) where correlation of pathology to the study lesion was not possible or incomplete. 570 patients comprised the analysis set. Patient age, index tumor characteristics (histologic subtype, grade, ER/PR status, HER2 status and presence of angiolymphatic invasion), axillary lymph node status, and pathologic stage were recorded in addition to mammographic breast density. All MR exams were coded following the American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS) breast MRI lexicon. Biopsy rates, positive predictive values of biopsy, and overall yield of detecting an occult cancer in the ipsilateral or contralateral breast were calculated and compared using Chi-square test across patient age, mammographic breast density, index tumor type, receptor status and presence or absence of lymph node metastases.Results. The distribution of tumor histologies was typical of that seen in the U.S. during the study period, with 61% having invasive ductal index cancers, 21% pure ductal carcinoma in situ, 19% invasive lobular or other invasive cancers and 67% being node negative at time of diagnosis. Additional biopsy was recommended for 152/570 (27%) patients found to have one or more suspicious lesions on MRI distinct from the index cancer, based upon mammographic, sonographic, or clinical exam measurements. Of the 152 women who underwent biopsy, 67 women had additional cancers diagnosed, for a positive predictive value of 44% (67/152). Overall, 12% (67/570) of women had otherwise occult cancers diagnosed by MRI alone: 8% of women had additional sites or greater extent of ipsilateral disease and 4% of women had unsuspected contralateral cancer detected by MRI alone. No significant differences were found in the probability of detecting an occult cancer based on patient age, breast density, index tumor characteristics, or lymph node status.Conclusion. The 12% added cancer yield of MRI in detecting additional ipsilateral or contralateral malignancies in a clinical population of women recently diagnosed with breast cancer is significantly higher than the added cancer yield of MRI screening among women at high risk for breast cancer. The positive predictive value of MRI in this clinical setting is also high, with 44% of women who undergo additional tissue sampling being diagnosed with otherwise occult cancer. The probability of finding additional malignancy does not vary significantly with patient age, breast density, or index cancer characteristics. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4017.

How Much Tissue Sampling Is Required When Unsuspected Minimal Prostate Carcinoma Is Identified on Transurethral Resection?

When minimal prostate cancer is detected in the initial transurethral resection of the prostate (TURP) sample, it is uncertain how extensively the remaining tissue should be sampled for accurate grading and staging. To identify whether additional partial or complete sampling is required to accurately evaluate TURP samples with minimal cancer (stage T1a). We prospectively examined all TURP samples in our institution during 1 year. All specimens were sampled randomly in 6 cassettes. When minimal cancer was found, we performed additional partial sampling (1 block per 5 g of remaining tissue), followed by complete submission of all remaining tissue. All samples were evaluated separately to identify possible changes in Gleason score and tumor volume. We performed a cost analysis for the additional tissue sampling. Of 747 TURP samples evaluated on the initial 6 cassettes, 125 (16.7%) contained prostate cancer. Minimal cancer involving less than 5% of sampled tissue was found in the initial submission in 26 (3.5%) patients. Additional partial examination required 3.5 blocks per case (median; range, 1-23), while complete processing required an additional 5.5 blocks per case (median; range, 2-25). Initial Gleason scores and tumor volumes were not changed in any of the studied cases after evaluating the additional partial and complete samples. In our laboratory, we calculated a cost of $4336 per year for the additional sampling of TURPs with minimal cancer ($1681 for partial and $2655 for complete sampling). When minimal cancer was found in the first 6 cassettes of transurethral resections, additional partial and complete sampling did not change the initial Gleason scores and tumor volumes.

How much tissue sampling is required when unsuspected minimal prostate carcinoma is identified on transurethral resection

Abstract Context.—When minimal prostate cancer is detected in the initial transurethral resection of the prostate (TURP) sample, it is uncertain how extensively the remaining tissue should be sampled for accurate grading and staging. Objective.—To identify whether additional partial or complete sampling is required to accurately evaluate TURP samples with minimal cancer (stage T1a). Design.—We prospectively examined all TURP samples in our institution during 1 year. All specimens were sampled randomly in 6 cassettes. When minimal cancer was found, we performed additional partial sampling (1 block per 5 g of remaining tissue), followed by complete submission of all remaining tissue. All samples were evaluated separately to identify possible changes in Gleason score and tumor volume. We performed a cost analysis for the additional tissue sampling. Results.—Of 747 TURP samples evaluated on the initial 6 cassettes, 125 (16.7%) contained prostate cancer. Minimal cancer involving less than 5% of sampled tissue ...

Mise au point sur la place de l'IRM dans le bilan initial du cancer du sein localisé

MR Imaging is the most sensitive technique for detecting breast cancer. In patients with breast cancer, the additional value of MRI is validated in patients candidates for a breast-conserving surgery and when: cancer is occult, size evaluation is difficult at standard imaging, parietal involvement is suspected, and before neoadjuvant chemotherapy. In fatty breasts, MRI is not routinely recommended, because of same performances as in standard imaging. In dense breasts, MRI becomes significantly more sensitive than mammography for detecting multifocality and multicentricity with a positive predictive value of 60% for detected additional foci. Thus, a decision of mastectomy should not be made solely on the basis of MRI and may require additional tissue sampling of areas of concern identified by breast MRI. The additional value of breast MRI is particularly useful in patients with dense breasts and high risk factors for local recurrence: young age (< 40 years), familial high risk, or because of a high-grade invasive cancer greater than 2 cm in size. Performing breast MRI in such patients underlies requirements: an expert breast imaging team, optimal MRI protocols, and radiologists working in concert with the multidisciplinary treatment team.

Palpable breast masses: is there a role for percutaneous imaging-guided core biopsy?

The purpose of this study was to evaluate percutaneous imaging-guided core biopsy in the assessment of selected palpable breast masses. Of 1388 consecutive breast lesions that had percutaneous imaging-guided core biopsy, 155 (11%) were palpable. Palpable masses referred for percutaneous imaging-guided core biopsy included lesions that were small, deep, mobile, vaguely palpable, or multiple. Biopsy guidance was sonography in 140 lesions (90%) and stereotaxis in 15 (10%). Surgical correlation or minimum of 2 years follow-up is available in 115 palpable masses in 107 women. Medical records, imaging studies, and histologic findings were reviewed. Of 115 palpable breast masses, 98 (85%) were referred by surgeons to the radiology department for percutaneous imaging-guided core biopsy and 88 (77%) had percutaneous imaging-guided core biopsy on the day of initial evaluation at our institution. Percutaneous imaging-guided core biopsy spared additional diagnostic tissue sampling in 79 (74%) of 107 women, including 57 women with carcinoma and 22 women with benign findings. Percutaneous imaging-guided core biopsy did not spare additional tissue sampling in 28 women (26%), including 15 women in whom surgical biopsy was recommended on the basis of percutaneous biopsy findings and 13 women with benign (n = 7) or malignant (n = 6) percutaneous biopsy findings who chose to undergo diagnostic surgical biopsy. Percutaneous imaging-guided core biopsy is useful in the evaluation of palpable breast masses that are small, deep, mobile, vaguely palpable, or multiple. In this study, percutaneous imaging-guided core biopsy spared additional diagnostic tissue sampling in 74% women with palpable breast masses.