Biopsies Of Benign Lesions Research Articles

Downgrading Breast Imaging Reporting and Data System categories in ultrasound using strain elastography and computer-aided diagnosis system: a multicenter, prospective study.

To determine whether adding elastography strain ratio (SR) and a deep learning based computer-aided diagnosis (CAD) system to breast ultrasound (US) can help reclassify Breast Imaging Reporting and Data System (BI-RADS) 3 and 4a-c categories and avoid unnecessary biopsies. This prospective, multicentre study included 1049 masses (691 benign, 358 malignant) with assigned BI-RADS 3 and 4a-c between 2020 and 2022. CAD results was dichotomized possibly malignant vs. benign. All patients underwent SR and CAD examinations and histopathological findings were the standard of reference. Reduction of unnecessary biopsies (biopsies in benign lesions) and missed malignancies after reclassified (new BI-RADS 3) with SR and CAD were the outcome measures. Following the routine conventional breast US assessment, 48.6% (336 of 691 masses) underwent unnecessary biopsies. After reclassifying BI-RADS 4a masses (SR cut-off <2.90, CAD dichotomized possibly benign), 25.62% (177 of 691 masses) underwent an unnecessary biopsies corresponding to a 50.14% (177 vs. 355) reduction of unnecessary biopsies. After reclassification, only 1.72% (9 of 523 masses) malignancies were missed in the new BI-RADS 3 group. Adding SR and CAD to clinical practice may show an optimal performance in reclassifying BI-RADS 4a to 3 categories, and 50.14% masses would be benefit by keeping the rate of undetected malignancies with an acceptable value of 1.72%. Leveraging the potential of SR in conjunction with CAD holds immense promise in substantially reducing the biopsy frequency associated with BI-RADS 3 and 4A lesions, thereby conferring substantial advantages upon patients encompassed within this cohort.

Machine learning can reliably predict malignancy of breast lesions based on clinical and ultrasonographic features.

To establish a reliable machine learning model to predict malignancy in breast lesions identified by ultrasound (US) and optimize the negative predictive value to minimize unnecessary biopsies. We included clinical and ultrasonographic attributes from 1526 breast lesions classified as BI-RADS 3, 4a, 4b, 4c, 5, and 6 that underwent US-guided breast biopsy in four institutions. We selected the most informative attributes to train nine machine learning models, ensemble models and models with tuned threshold to make inferences about the diagnosis of BI-RADS 4a and 4b lesions (validation dataset). We tested the performance of the final model with 403 new suspicious lesions. The most informative attributes were shape, margin, orientation and size of the lesions, the resistance index of the internal vessel, the age of the patient and the presence of a palpable lump. The highest mean negative predictive value (NPV) was achieved with the K-Nearest Neighbors algorithm (97.9%). Making ensembles did not improve the performance. Tuning the threshold did improve the performance of the models and we chose the algorithm XGBoost with the tuned threshold as the final one. The tested performance of the final model was: NPV 98.1%, false negative 1.9%, positive predictive value 77.1%, false positive 22.9%. Applying this final model, we would have missed 2 of the 231 malignant lesions of the test dataset (0.8%). Machine learning can help physicians predict malignancy in suspicious breast lesions identified by the US. Our final model would be able to avoid 60.4% of the biopsies in benign lesions missing less than 1% of the cancer cases.

Non-Invasive Diagnosis of Angioma Serpiginosum Plantaris: High-Resolution Dermoscopy, High-Frequency Ultrasound, and Line-Field Confocal Optical Coherence Tomography

We present a comprehensive study of acral serpiginous hemangioma, a rare vascular pathology. This distinctive manifestation was examined for the first time using high-resolution video dermoscopy (HRVD), high-frequency ultrasound (HFUS), and line-field confocal optical coherence tomography (LC-OCT). The combined application of these techniques provides new and detailed morphological features able to determine the in vivo structure of lesional skin. This innovative non-invasive approach emphasizes the importance of incorporating advanced diagnostic tools able to provide a virtual histology in order to avoid unnecessary biopsies in benign lesions, often causing pain and functional/aesthetic discomfort.

DIAGNOSTIC ACCURACY OF ULTRASOUND BI-RADS IN DIAGNOSING BREAST LESIONS UTILIZING THE CORE NEEDLE BIOPSY KEEPING HISTOPATHOLOGY AS A GOLD STANDARD

Objective: To determine the diagnostic accuracy of Ultrasound BI-RADS classification in diagnosing breast lesions utilizing the core needle biopsy method keeping histopathology as a gold standard. Materials and Methods: A cross-sectional study was conducted in the Radiology department of CMH Peshawar incorporating 51 patients having breast lesions as presenting complaints. After performing ultrasonography, lesions were categorized as benign and malignant according to BI-RADS scoring. A core needle Biopsy of lesions was done and histopathology reports were collected. Diagnostic accuracy, Sensitivity, Specificity, Positive predictive value, and Negative predictive value of “BI-RADS classification were calculated by analyzing data. Results: The mean age was calculated as 45.63+ 16.83 years. According to the BI-RADS score, 17 cases (33.3%) were categorized as benign and 35 cases (66.7%) as malignant while Histopathology reported 20 cases (39.2%) as benign while 31 cases (60.8%) as malignant. Diagnostic accuracy, Sensitivity, Specificity, Positive predictive value, and Negative predictive value for ultrasound BI-RADS turned out to be 90.19%, 96.77 %, 80.00%, 88.23%, and 94.11% and respectively. Conclusion: Ultrasound BI-RADS classification has high diagnostic accuracy in differentiating benign from malignant lesions. Universal application of ultrasound BI-RADS guidelines will help in the early diagnosis of malignant breast lesions while avoiding unnecessary biopsies in benign lesions. Keywords: Breast imaging, Core needle biopsy, Diagnostic accuracy

Prevalence and consequences of non-adherence to an evidence-based approach for incidental pulmonary nodules.

Distinguishing benign from malignant pulmonary nodules is challenging. Evidence-based guidelines exist, but their impact on patient-centered outcomes is unknown. To understand if the evaluation of incidental pulmonary nodules that follows an evidence-based management strategy is associated with fewer invasive procedures for benign lesions and/or fewer delays in cancer diagnosis. Retrospective cohort study. Large academic medical center. Adults (≥18 years age) with an incidental pulmonary nodule discovered between January 2012 and December 2014. Patients with calcified nodules, prior nodules, prior diagnosis of cancer, high suspicion for pulmonary metastasis, or limited life expectancy were excluded. Nodule management strategy (pre-specified based on evidence-based practices). Composite of any invasive procedure for a benign nodule or delay in diagnosis in patients with cancer (>3 month delay once probability of cancer was >15%). Of 314 patients that met inclusion criteria, median age was 61, 46.5% were men, and 66.5% had current or former tobacco use. The mean nodule size was 10.3 mm, mean probability of cancer was 11.8%, and 14.3% of nodules were malignant. Evaluation followed an evidence-based strategy in 245 patients (78.0%), and deviated in 69 patients (22%). The composite outcome occurred in 26 (8.3%) patients. Among patients whose nodule evaluation was concordant with an evidence-based evaluation, 6.1% (15/245) experienced the composite outcome versus 15.9% (11/69) of patients with an evaluation that deviated from evidence-based recommendations (P<0.01). At a large academic medical center, more than 1 in 5 patients with an incidental pulmonary nodule underwent evaluation that deviated from evidence-based practice recommendations. Nodule evaluation that deviated from an evidence-based strategy was associated with biopsy of benign lesions and delays in cancer diagnosis, suggesting a need to improve guideline uptake.

The potential of combined shear wave and strain elastography to reduce unnecessary biopsies in breast cancer diagnostics – An international, multicentre trial

BackgroundShear wave elastography (SWE) and strain elastography (SE) have shown promising potential in breast cancer diagnostics by evaluating the stiffness of a lesion. Combining these two techniques could further improve the diagnostic performance. We aimed to exploratorily define the cut-offs at which adding combined SWE and SE to B-mode breast ultrasound could help reclassify Breast Imaging Reporting and Data System (BI-RADS) 3-4 lesions to reduce the number of unnecessary breast biopsies. MethodsWe report the secondary results of a prospective, multicentre, international trial (NCT02638935). The trial enrolled 1288 women with BI-RADS 3 to 4c breast masses on conventional B-mode breast ultrasound. All patients underwent SWE and SE (index test) and histopathologic evaluation (reference standard). Reduction of unnecessary biopsies (biopsies in benign lesions) and missed malignancies after recategorising with SWE and SE were the outcome measures. ResultsOn performing histopathologic evaluation, 368 of 1288 breast masses were malignant. Following the routine B-mode breast ultrasound assessment, 53.80% (495 of 920 patients) underwent an unnecessary biopsy. After recategorising BI-RADS 4a lesions (SWE cut-off ≥3.70 m/s, SE cut-off ≥1.0), 34.78% (320 of 920 patients) underwent an unnecessary biopsy corresponding to a 35.35% (320 versus 495) reduction of unnecessary biopsies. Malignancies in the new BI-RADS 3 cohort were missed in 1.96% (12 of 612 patients). ConclusionAdding combined SWE and SE to routine B-mode breast ultrasound to recategorise BI-RADS 4a patients could help reduce the number of unnecessary biopsies in breast diagnostics by about 35% while keeping the rate of undetected malignancies below the 2% ACR BI-RADS 3 definition.

Is breast MRI a helpful additional diagnostic test in suspicious mammographic microcalcifications?

PurposeMicrocalcifications are a common finding in mammography and usually require invasive procedures to diagnose or exclude malignancy. As many microcalcifications are due to benign lesions, we wanted to assess whether breast MRI as an additional diagnostic tool may be used to distinguish benign from malignant in this setting. Materials and methodsEligible for this retrospective, IRB-approved observational study were 858 consecutive patients (mean age 54±11years) undergoing stereotactically-guided biopsies of suspicious mammographic microcalcifications during three year at our institution. Finally included were 152 patients who also underwent breast MRI <8weeks prior to biopsy. In case of malignant or lesions of uncertain malignant potential, subsequent surgery was performed. Benign findings were confirmed by imaging follow-up. BI-RADS category assignments from the original mammography and breast MRI reports were compared to the final diagnosis (benign vs. malignant) to determine diagnostic benchmarks. ResultsHistopathology revealed 81 benign (53.3%), 41 DCIS (27%) and 30 (19.7%) invasive cancers. Sensitivity, specificity, positive and negative predictive values for breast MRI were 97.2% (69/71), 39.5% (32/81), 58.5% (69/118) and 94.1% (32/34), respectively. Thus, 32/81 unnecessary biopsies in benign lesions (39.5%) may have been avoided, missing 2/71 malignant lesions (2.8%), both DCIS G2. ConclusionBreast MRI as an additional diagnostic tool can be used to accurately distinguish benign from malignant mammographic microcalcifications and may thus be helpful to reduce unnecessary breast biopsies.

Differential Diagnosis of Seborrheic Keratosis: Clinical and Dermoscopic Features.

<p>Seborrheic keratosis (SK) is a benign epidermal keratinocytic tumor that is extremely common, particularly in individuals over the age of 50. Most individuals with SK will have more than one lesion and the presence of over 10 lesions in the same person is not uncommon. Although the clinical morphology of most SK with their stuck-on, symmetric, keratotic, and waxy appearance makes them easy to identify, many manifest a morphology resembling melanoma or squamous cell carcinoma. One can argue that such cases will ultimately not prove to be problematic since a simple biopsy will easily reveal their benign nature and eliminate any concerns. However, the cost and morbidity associated with the biopsy of benign lesions should not be underestimated. Methods to improve our in vivo ability to correctly identify SK will prove beneficial not only to the health care system in general but to the individual patient specifically. The issue of greater concern resides with skin cancers that mimic SK or when skin cancers arise in association with SK. Needless to say, in vivo methods to help identify malignancy and differentiate them from benign lesions would be welcomed by all. Fortunately, we do now have in vivo imaging methods such as dermoscopy that can improve the clinician's diagnostic accuracy. In this article, we summarize the current knowledge regarding the clinical and dermoscopic features of SK, and provide clues to aid in their diagnosis.</p> <p><em>J Drugs Dermatol. 2017;16(9):835-842.</em></p>.

Reflectance confocal microscopy of skin in vivo: From bench to bedside.

Following more than two decades of effort, reflectance confocal microscopy (RCM) imaging of skin was granted codes for reimbursement by the US Centers for Medicare and Medicaid Services. Dermatologists in the USA have started billing and receiving reimbursement for the imaging procedure and for the reading and interpretation of images. RCM imaging combined with dermoscopic examination is guiding the triage of lesions into those that appear benign, which are being spared from biopsy, against those that appear suspicious, which are then biopsied. Thus far, a few thousand patients have been spared from biopsy of benign lesions. The journey of RCM imaging from bench to bedside is certainly a success story, but still much more work lies ahead toward wider dissemination, acceptance, and adoption. We present a brief review of RCM imaging and highlight key challenges and opportunities. The success of RCM imaging paves the way for other emerging optical technologies, as well-and our bet for the future is on multimodal approaches. Lasers Surg. Med. 49:7-19, 2017. © 2016 Wiley Periodicals, Inc.

Detailed microarchitecture analysis of breast tumors using diffusion tensor imaging

Introduction Conventional breast MRI has shown high diagnostic sensitivities for the detection of breast cancer, whereas relatively low specificities have been reported, resulting in many unnecessary biopsies of benign lesions. Purpose The main purpose of this study was to investigate whether diffusion measures of anisotropy (DWI & DTI) can improve the discrimination between benign and malignant lesions. Moreover, using detailed DTI microstructure analysis, we sought to investigate the contribution of the architecture of breast fibroglandular tissue in the differential diagnosis of malignancy. Methods and materials The study included 58 women with a total of 86 breast lesions. DTI and DWI were performed complementary to dynamic contrast MRI. Apparent diffusion coefficient (ADC), mean diffusivity (MD) and fractional anisotropy (FA) were measured for lesions and contralateral breast parenchyma of each patient. All values were compared between malignant, benign lesions and the normal parenchyma by univariate and multivariate analyses. Results The FA values showed high variation and hence moderate statistical significance. Nevertheless the analysis of DTI vector maps and parametric maps, revealed significantly lower values of the tumor’s orthogonal diffusion coefficients λ1, λ2, λ3 comparing to normal breast and benign tissue. Despite the significant overlap the FA values of malignant tissue were significantly higher than normal and benign tissue (p = 0.002). ROC curve analysis was also performed for every discrimination factor studied. Conclusion ADC measures have accurate discrimination ability in all cases. Careful microstructural analysis revealed significantly lower values of the tumor’s prime diffusion coefficient λ1, and may be used as a potential indicator.

The role of fine needle aspiration cytology and core biopsy in the diagnosis of palpable breast masses

Background:The modern approach to palpable breast masses is to get cytopathologic diagnosis before definitive surgery. We aimed to compare fine needle aspiration cytology (FNAC) with core biopsy in histopathologic diagnosis of palpable breast masses.Materials and Methods:Data were collected on 123 women who have suspicious palpable breast masses from 2007 to 2010.Results:Of the 123 patients, core biopsies were performed on 64 patients (Group 1) and FNAC on 59 patients (Group 2). Malignancy was confirmed in 25 out of 32 clinically suspicious patients in Group 1 (78.1%), and 20 out of 21 participants in Group 2 (95.2%). Among the clinically suspicious patients, 81.8% of 33 patients in Group 1, and 90.3% of 31 patients in Group 2 were identified malignancy. Sensitivity was 100% for core biopsy and 95% for FNAC. Specificity was 100% in both procedures. False negativity rate in FNAC were 5%.Conclusion:Sensitivity and specificity showed that in the case of true histopathologic classification, core biopsy is superior to FNAC. Nevertheless, FNAC's role as a fast, simple and cheap diagnosis cannot be ignored. It is an effective diagnostic tool in most patients, in comparison to the correct and specific typing of core biopsies in benign lesions which protect patients from the open biopsy.

Incremental value of real-time ultrasound elastography in differentiating breast masses

Aim of the workTo evaluate the value of real-time ultrasound elastography (RTE) in differentiating benign from malignant breast masses. Materials and methodsThis study included, whether palpable or non-palpable, 145 sonographically proven breast masses in 121 patients, imaged by conventional B-mode US, color-flow Doppler US and RTE with histopathological analysis considered as the golden standard reference. ResultsLesions were differentiated into benign and malignant by conventional B-mode US (79; 45.5% and 66; 54.5%, respectively), RTE (80; 55.2% and 65; 44.8% respectively), and histopathology (82; 56.6% and 63; 43.4%, respectively). The mean difference in the mass size was significant between B-mode US and RTE in malignant masses (P=0.002), while not significant among benign masses (P=0.153). The B-mode US depicted sensitivity of 92.06%, specificity of 90.24%, PPV of 87.88%, NPV of 93.67% and accuracy of 91.03%, while the RTE showed sensitivity of 98.41%, specificity of 96.34%, PPV of 95.38%, NPV of 98.75% and accuracy of 97.24%. ConclusionCombined use of RTE can complement conventional B-mode US with improving its diagnostic performance in differentiating breast lesions with subsequent reduction in the rate of unnecessary biopsies in benign lesions.

Optimizing Breast Cancer Follow-Up: Diagnostic Value and Costs of Additional Routine Breast Ultrasound.

Abstract Background: Standard means in breast cancer follow-up include clinical examination and mammography for the detection of local recurrences. Additional test will only be conducted if there are unclear or suspicious findings. Ultrasound has not yet been established as a routine method for breast cancer follow-up care. Our study evaluates the diagnostic efficacy of breast ultrasound in detecting occult malignancies. Moreover, we analyzed the effect of false positive findings resulting in additional examinations and biopsies, and we conducted a benefit-cost-analysis and a questioning of the affected patients.Materials and Methods: A total of 879 eligible patients who were seen at the University Hospital of Saarland for the purpose of breast cancer follow-up were recruited between October 2004 and January 2006. All patients received clinical examination and mammography and were then divided into 2 groups. Group 1 (n=703) were clinically and mammographically asymptomatic patients. Group 2 (n=176) had abnormalities either in palpation or mammography. All patients received additional ultrasound in order to detect occult malignancies. Both groups were analyzed with respect to the diagnostic value of additional ultrasound, the rate of additional examinations and biopsies, the extra costs and the individual stress as experienced by the patient.Results: In group 1 (asymptomatic patients) 10 occult malignancies were detected due to the additional ultrasound examination, i.e. one diagnosed malignancy in 70 examined patients (detection rate 1.4%). By reason of false positive ultrasound results, 65 additional control-ultrasounds, 14 additional MRI examinations and finally 22 biopsies of benign lesions were unnecessarily conducted. Weighing in the total costs for ultrasound, MRI and biopsy, an amount of 4150€ (5290$) was spent to find one additional cancer.In group 2, apart from the symptomatic lesions, 3 occult malignancies were exclusively identified due to the ultrasound examination (detection rate 1.7%). On the other hand, false positive ultrasound results caused 7 additional control-ultrasounds, 14 additional MRIs and 11 biopsies of benign lesions. Hence, an amount of 4410€ (5620$) was spent to identify one additional malignancy by the means of additional ultrasound in this group.Overall, 50 patients (5.7%) received biopsy due to false positive results either in ultrasound or mammography, but these patients claimed on questioning not to feel “troubled and anxious”, but “saver and more carefully looked after”.Discussion: Regarding our results, we strongly recommend the routine use of ultrasound in breast cancer follow-up for both, asymptomatic and symptomatic, women, as occult malignancies can be identified cost-efficiently, although additional ultrasound may also result in higher false positive findings. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5027.

Lipid‐rich hepatocellular carcinoma in fine‐needle aspiration biopsy

The histology of hepatocellular carcinoma is typically characterized by thickened trabeculae of malignant hepatocytes in a background of a cirrhotic liver. Hepatomas are divided by the World Health Organization into well, moderately, poorly, and undifferentiated grades. Four common architectural patterns such as trabecular, solid, pseudoglandular, and scirrhous, and three cytologic variants such as pleomorphic, clear cell, and sarcomatoid are recognized. In the clear cell variant, cytoplasmic alterations are related to glycogen and/or lipid accumulation within the lesional cells. Clear cell variants of hepatocellular carcinoma are most often low-grade. In limited cytologic samples of low grade, lipid-containing hepatic malignancies, the separation of neoplastic cells from benign steatotic cells (as may be encountered with focal hepatic steatosis) can be extremely challenging. A 78-year-old woman with a documented history of hepatocellular carcinoma presented with a new 1.5 cm, PET positive nodule in the right lobe of the liver. She had undergone left hepatic lobectomy (six years remote) for a 7-cm well-differentiated hepatocellular carcinoma and more recently (one year prior) had undergone a right hepatic lobe wedge resection for recurrent disease. A radiologically guided fine-needle aspiration biopsy of the new liver nodule was performed. The air-dried Diff-Quik stained slides revealed scattered bland hepatocytes with abundant vacuolated cytoplasm (Fig. C-1). An immediate interpretation was rendered as hepatocytes present, with a considered differential diagnosis of a lipid-containing hepatoma versus steatosis. Alcohol-fixed Papanicolaou stained slides showed a strikingly uniform and deceptively bland population of neoplastic hepatocytes with micro and macro-vesicular steatotic changes (Fig. C-2). Correlations with slides from the patient’s previously resected recurrent hepatocellular carcinoma confirmed the nuclei in the known malignant cells to be deceptively innocuous and the cytoplasm in these same cells to be lipid-rich (Fig. C-3). Differentiation of well-differentiated hepatocellular carcinoma from benign changes including steatosis has been studied by Yang et al. They found that fineneedle aspiration biopsies of benign lesions contained rigid cores and large tissue fragments in contrast to welldifferentiated hepatocellular carcinoma in which there was a breakdown of the reticulin framework with scattered cells and a fine granular appearing background. Lipid-rich hepatocellular carcinoma is an uncommon variant, and it is possible that lesional cells from this entity may be under diagnosed as simple steatosis (Fig. C-4). This case highlights this potential pitfall.

Assessment of Suspected Breast Cancer by MRI: A Prospective Clinical Trial Using a Combined Kinetic and Morphologic Analysis

The objective of our study was to assess the incremental value of contrast-enhanced MRI in the diagnosis and treatment planning using both a three-time point kinetic and morphologic analysis in addition to mammography and sonography in patients thought to have early-stage breast cancer. Contrast-enhanced bilateral breast MRI was performed prospectively on 65 patients with highly suspicious imaging findings (BI-RADS category 4 or 5). All enrolled patients were believed to be candidates for breast conservation on the basis of clinical examination, mammography, and sonography. The primary index lesion's characteristics, size, and extent were assessed. Also, additional lesions detected by MRI that could represent potential malignancies in both the ipsilateral and contralateral breast were evaluated. Morphologic assessment and kinetic analysis were performed on each lesion using dedicated postprocessing and display software. The patients were reevaluated as to whether they were still candidates for breast-conservation therapy after the MRI examination and subsequent biopsies. There were 46 patients (71%) whose primary breast lesion (detected by mammography, sonography, or both) was found to be malignant (39 invasive breast cancers, five intraductal cancers, and two lymphomas). For the primary index lesions, the sensitivity for MRI was 100% (44/44) for predicting a breast malignancy and the specificity was 73.7% (14/19) for predicting benign lesions. MRI detected an additional 37 lesions, of which 23 were cancerous, beyond those suspected on mammography or sonography. One or more additional ipsilateral breast cancers were detected in 32% (14/44) of breast cancer patients and contralateral breast cancers in 9% (4/44) of the breast cancer patients. MRI also resulted in an incremental recommendation of mastectomy in 18% (8/44) of the pathologically confirmed breast cancer patients. MRI resulted in additional biopsy of only 14 benign lesions, six of which were shown to be atypical ductal hyperplasia. When added to the standard evaluation of clinical examination, mammography, and sonography in patients thought to have early-stage breast cancer, contrast-enhanced MRI using both a kinetic and morphologic analysis will often result in changes in recommended patient management and better treatment planning and will result in no significant increase in biopsies of benign lesions. In addition, there is a significant detection rate of occult contralateral breast cancers.

Low-dose CT: new tool for screening lung cancer?

Lung cancer is the leading cause of death from malignant tumours as it is very common and has a poor prognosis at advanced tumour stages. Prognosis could be improved by treatment at early stages. As these stages are usually asymptomatic, a diagnostic test that would allow detection of early tumour stages in a population at risk could potentially reduce mortality from lung cancer. Previous approaches using chest radiography and sputum cytology in smokers have been disappointing. Fluorescent bronchoscopy and molecular markers are not yet applicable in clinical routine. Because of its high sensitivity for small pulmonary nodules, which are the most common manifestation of early lung cancer, CT appears suitable as a screening test. Low-dose examination parameters can and should be used for this purpose. From clinical practice it is well known that chest CT often demonstrates small pulmonary nodules, which do not represent lung cancer. Therefore, non-invasive diagnostic algorithms are required to avoid unnecessary biopsies in benign lesions. In preliminary studies of low-dose CT using algorithms based on size and density of detected nodules a large proportion of asymptomatic lung cancers and a large proportion of early, resectable tumour stages were found with a small proportion of invasive procedures for benign nodules. Before this technology can be recommended for broad application, however, further information is required regarding appropriate inclusion criteria (smoking habits, age groups) and screening intervals. Most importantly, further data are required to clarify whether lung cancer screening using low-dose CT can actually reduce mortality from lung cancer.

Yield of Terminal Duct Lobule Units in Normal Breast Stereotactic Core Biopsy Specimens: Implications for Biomarker Studies.

The purpose of this study was to assess the potential value of large-needle core biopsies of normal breast tissue for immunohistochemical studies of epithelial risk assessment. A retrospective analysis was performed to determine the yield of nonatrophic terminal duct lobule units (TDLUs) in 11-gauge vacuum-assisted core biopsies of normal adjacent breast tissue which were included in routine stereotactic core biopsies of benign lesions. Fifty-one patients had a median of two normal tissue cores (range 1-7); 82% of the patients had two or more normal tissue cores; 47% had three or more normal tissue cores. Nonatrophic TDLUs were present in only 47% of patients and in 31% (42 of 137) of all cores. Patients with heterogeneous or dense normal mammographic parenchyma at the site of the biopsy were more likely to have nonatrophic TDLUs, 45% (20 of 44), than patients with fatty normal mammographic parenchyma at the biopsy site, 0% (0 of 7), p = 0.007. Seventy percent (7 of 10) of postmenopausal women on hormone replacement therapy had nonatrophic TDLUs as compared to 41% (11 of 27) of premenopausal and postmenopausal women not on hormones (p = not significant). Eleven-gauge vacuum-assisted core biopsies of normal breast tissue have a low yield of nonatrophic TDLUs suitable for histochemical studies of epithelial risk assessment.

Can apoptosis in benign proliferative lesions predict risk of cancer development?

The presence of benign proliferative lesions is a risk factor for the development of cancer. However, only a subset of individuals presenting with benign lesions goes on to develop cancer. It is a major challenge of cancer research to identify those individuals at increased risk for this neoplastic progression. It has been suggested that individuals with inherent genomic instability may have a predisposition for cancer development. The hypothesis is presented that this genetic instability could be quantified through the analysis of apoptosis in biopsies of benign lesions. It is further conjectured that genetic damage-dependent apoptosis might serve as a prognostic indicator to identify individuals at increased risk for cancer.