Breast Core Biopsy Research Articles

Abstract P2-10-27: No Discordant Receptor Status Results among 50 Paired Breast and Axillary Metastasis Core Biopsies when Pre-analytic Variation is Controlled.

Abstract Background: Discrepancy in Her2, estrogen receptor (ER), and progesterone receptor (PR) status among primary breast tumors and their axillary lymph node metastases has been reported in the range of 6–18%, leading to uncertainty as to the optimal sample for testing. It has been hypothesized this reflects heterogeneity within a given patient's tumor, however the pre-analytic conditions (particularly time to fixation and fixation duration) for samples in these studies were either nonuniform for the sample pairs or else unspecified. Altered tissue antigenicity rather than true biologic alterations in receptor expression may account for some the discrepancy reported in the literature. This study of paired primary and metastatic tumors processed in a uniform fashion attempts to address this issue. Design: Core biopsy samples from 50 primary invasive ductal carcinomas and their corresponding ipsilateral axillary lymph node metastases obtained at the same procedure, using the same core biopsy sampling device, fixed under the same conditions, stained on the same staining runs, and analyzed using digital image analysis comprise the study cohort. Patient demographics and tumor characteristics (from subsequent excision specimens or clinical imaging) were obtained from medical records. Results: Complete agreement in Her2, ER, and PR scores was seen among all paired samples. The mean age of the 50 women was 51.72 (27–86). Mean time to fixation was 2.55 minutes and the mean duration of fixation was 12.87 hours (6.4–29.7). The Her2 scores were 0 = 2, 1+ = 13, 2+ = 12, 3+ = 23. For 3+ cases, the mean tumor size was 3.47 cm, 44% were ER negative and the mean tumor grade was 2.61 (of 3). For 0/1+ cases, the mean tumor size was 3.86 cm, the mean tumor grade was 2.46 (38% were grade 3 and triple negative). The ER (Allred) scores were 0 = 17, 3 = 1, 4 = 1, 5 = 3, 6 = 9, 7 = 7, 8 = 12. For ER negative tumors the mean tumor grade was 2.76. For ER positive tumors the mean tumor grade was 2.39 including all 3 grade 1 tumors. Only minor discrepancies in Allred scores occurred between the paired samples; 5 with a difference of 1 (6–7, 7–8, 8–7, 7–6, 8–7); and one with a difference of 2 (8–6). The PR (Allred) scores were 0 = 24, 2 = 3, 3 = 4, 4 = 8, 5 = 2, 6 = 6, 7 = 1. For PR negative tumors the mean tumor grade was 2.75. For PR positive tumors the mean tumor grade was 2.40, including all 3 grade 1 tumors. Only minor discrepancies in Allred scores occurred between the paired samples; 4 with a difference of 1 (3–4, 4–5, 4–5, 6–7); and three with a difference of two (3–5, 4–6, 4–6). The mean age did not differ significantly by any receptor status. Conclusion: Under matched processing conditions, these 50 paired primary breast tumors and their corresponding lymph node metastases show congruent Her2 and ER staining results. This number of cases should have detected discrepancies in the range of 6–18%. Minor differences in staining intensity and %positive cells were noted, but none resulted in a positive vs negative mismatch. These data suggest the possibility that these minor differences, magnified through the influence of disparate fixation conditions, could account for the higher discrepancy rates reported in the literature. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-10-27.

Abstract P1-09-02: Pilot study of a 1-year intervention of high-dose vitamin D in women at high risk for breast cancer.

Abstract Background: Selective estrogen receptor modulators (SERMs) have been shown to decrease breast cancer incidence among high-risk women, but uptake for prevention has been poor. Observational studies have demonstrated that serum 25-hydroxyvitamin D (25-OHD) is inversely related to breast cancer risk, such that levels >40 ng/ml are associated with about a 40% reduction in breast cancer risk compared to women who are vitamin D deficient (25-OHD <20 ng/ml). Uncertainty remains about whether vitamin D supplementation will reduce breast cancer risk, the optimal dose of vitamin D, and the target level of serum 25-OHD. We examined the safety of high dose vitamin D and the effects on serum 25-OHD in women at high risk for breast cancer. Methods: Forty high-risk women (defined as a 5-year Gail risk ³1.67%, lobular or ductal carcinoma in situ [LCIS/DCIS], BRCA1/BRCA2 mutation carrier, or stage I/II invasive breast cancer in remission for >5 years) were assigned to a 1-year intervention of vitamin D3 20,000 or 30,000 IU weekly. Other eligibility criteria included baseline mammographic density (MD) ≥25%, serum 25-OHD ≤32 ng/ml, no current SERM use and no history of kidney stones. Women underwent a digital mammogram at baseline and 12 months, and serial blood draws every 3 months. In addition, random core breast biopsies were conducted in premenopausal women, whereas postmenopausal women underwent a breast MRI at baseline and 12 months. Participants were monitored for toxicity, particularly hypercalcemia and hypercalciuria, every 3 months. The primary objective is to determine the safety and feasibility of high-dose vitamin D in this study population. Secondary objectives are to determine changes in breast density and blood-based biomarkers (25-OHD, 1,25(OH)D, PTH, IGF-I, IGFBP-3). Serum 25-OHD was measured by Diasorin radioimmunoassay. Results: From November 2007 to January 2011, 292 women were screened and 142 were ineligible. Main reasons for ineligibility (%) included 25-OHD >32 ng/ml (27), opted for SERM (23), prior kidney stones (11), and MD <25% (9). Of the 40 enrolled participants: median age 50 years (range, 37–73); pre/postmenopausal: 20/20; white/hispanic/black/asian: 19/14/6/1; median body mass index 26.6 kg/m2 (20–39.6); elevated Gail risk/LCIS/DCIS/stage I or II breast cancer: 20/10/8/2; mean baseline serum 25-OHD 20.2 ng/ml (9–31). Currently, 1 participant is on-study, 31 completed the intervention, 6 were lost to follow-up, 1 withdrew due to hypercalciuria (spot urine Ca/Cr >0.37) and 1 withdrew due to dyspepsia. Mean serum 25-OHD rose to 47 ng/ml at 3 months, 49.1 ng/ml at 6 months, and 53.7 ng/ml (range, 26–77) at 12 months. No significant hypercalcemia (serum Ca >10.5 mg/dl) occurred at either dose level. Imaging and biomarker analyses are ongoing. Discussion: We have demonstrated that a 1-year intervention of high-dose vitamin D3 is well tolerated and can increase serum 25-OHD above a target level of 40 ng/ml. This preliminary data has informed an ongoing phase IIb randomized placebo-controlled trial (SWOG 0812) of high-dose vitamin D in 200 high-risk premenopausal women and highlights the importance of early phase breast cancer chemoprevention trials with intermediate biomarker endpoints to test novel agents. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-09-02.

Mucocele-like Lesions Diagnosed on Breast Core Biopsy

Mucocele-like lesion (MLL) is a rare mucinous lesion of the breast with highly variable upgrade rates to atypia or malignancy on excision. This spectrum of data has led to differing opinions on the need for surgical excision. We evaluated 50 core biopsy specimens diagnosed as having MLLs and correlated the findings with those of excision pathology. Thirty-eight patients underwent surgical excision and 29 were benign (76%), 4 had atypical ductal hyperplasia (11%), and 5 had ductal carcinoma in situ (13%), with an overall upgrade rate of 13%. However, the risk of upgrade was exclusively associated with the presence of atypia as seen on the needle core biopsy. All 22 MLLs without atypia had benign excisions, while 5 (31%) of the 16 patients with MLLs with atypia were upgraded to ductal carcinoma in situ on excision. No invasive carcinoma was identified. We believe it is reasonable that women with the core biopsy diagnosis of MLL without atypia and no associated mass be offered close clinical follow-up as an alternative to surgery.

Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy

No consensus exists on the need to excise breast lesions that yield classic lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH) (known together as classic lobular neoplasia [LN]) as the highest risk lesion at percutaneous core-needle biopsy (CNB). Here, the authors report findings from 72 consecutive lesions with LN at CNB and prospective surgical excision (EXB). Lesions that yielded LN at CNB at the authors' center have been referred for EXB since June 2004, regardless of imaging-histologic concordance. A lesion was "concordant" if histologic findings provided sufficient explanation for imaging. An upgrade consisted of ductal carcinoma in situ and/or invasive carcinoma at EXB. Statistical analysis, including 95% confidence intervals (CIs), was performed. Between June 2004 and May 2009, CNB of 85 consecutive lesions yielded LN without other high-risk histologies. Eighty of 85 lesions (94%) underwent prospective EXB. Seventy-two of 85 lesions (90%; 42 LCIS, 30 ALH) had concordant imaging-histologic findings. EXB yielded low-grade carcinoma in 2 of 72 cases (3%; 95% CI, 0%-9%). In both patients, stereotactic, 11-gauge, vacuum-assisted biopsy of calcifications yielded calcifications in benign parenchyma and ALH. CNB results were discordant in 8 of 80 lesions (10%; 4 LCIS, 4 ALH), and EXB yielded cancer in 3 of those 8 lesions (38%; 95% CI, 9%-76%). The upgrade rate was significantly higher for discordant lesions versus concordant lesions (38% vs 3%; P < .01). Prospective excision of LN identified carcinoma in 3% (95% CI, 0%-9%) of concordant cases versus 38% (95% CI, 9%-76%) of discordant cases. The current data provide an unbiased assessment of the upgrade rate of LN diagnosed at CNB.

Histopathologic Characterization of Displaced Epithelium After Breast Core Biopsy

Histopathologic Characterization of Displaced Epithelium After Breast Core Biopsy

PO28 Review of indeterminate (B3) breast core biopsy in young women in one centre in southwest England

PO28 Review of indeterminate (B3) breast core biopsy in young women in one centre in southwest England

Columnar Cell Change With Atypia (Flat Epithelial Atypia) on Breast Core Biopsy-Outcomes Following Open Excision

Columnar cell change with atypia (CCCA) is a relatively recently recognized pathologic breast entity considered to be a risk factor for subsequent development of breast carcinoma. The aim of this study was to investigate the significance of finding CCCA on breast core biopsy, by establishing the frequency of other breast pathology on subsequently performed surgical excision specimens. All cases with CCCA as the most advanced lesion on core biopsy were reviewed. After excision, another advanced proliferative lesion was identified in 17 (33%) patients, including three patients (6%) with in situ or invasive carcinoma. An additional five patients (10%) were concurrently diagnosed with primary breast carcinoma at other sites. These findings indicate that when CCCA is found on core biopsy, open surgical biopsy of the relevant area should be performed and that workup of both breasts should be undertaken to exclude coexistent breast carcinoma at alternative sites.

P25. Free hand breast core biopsies in a selected group are as good as image guided biopsies

Introduction: There has been an increasing trend towards image guided core biopsy over free hand biopsy for symptomatic breast lesions. We aimed to study our own practice.

Is Excisional Biopsy Required After a Breast Core Biopsy Yields Lobular Neoplasia?

The management of lobular neoplasia (LN) on percutaneous core breast biopsies remains controversial. Published upgrade rates after surgical excision vary widely. This study aims to determine the frequency of malignancy following excision in patients with LN found on core biopsy. Our study identified patients from December 2005 through December 2010 with LN as the highest-risk lesion on core biopsy. Patients with flat epithelial atypia on core biopsy were not excluded. Per institutional policy, excision was routinely recommended. An upgrade from the core biopsy of LN was defined as excisional biopsy pathology that revealed ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), or invasive lobular carcinoma (ILC). Between December 2005 and December 2010, 4472 percutaneous breast biopsies were performed, with 71 patients (1.5%) having LN as the highest-risk lesion on core biopsy. Sixty-seven patients (94%) underwent excision. The upgrade rate on excisional biopsy was 16% (11/67 patients), with the type of malignancy on excisional biopsy pathology as follows: DCIS, 36% (4/11); IDC, 18% (2/11); and ILC, 45% (5/11). All patients with pleomorphic lobular carcinoma in situ on core biopsy who proceeded to excision were upgraded to malignancy. After excluding patients with discordant results, patients with pleomorphic lobular carcinoma in situ, and patients with flat epithelial atypia on core biopsy, the upgrade rate of pure LN on excisional biopsy was 9%. LN on core biopsy warrants excisional biopsy given the upgrade rate to malignancy.

An Exceptionally Rare Presentation of Adenocarcinoma of the Pancreas with Metastasis to the Breast: A Case Report

Purpose: Introduction: Pancreatic cancer is a poorly understood and devastating cancer. It is the fourth leading cause of cancer death with a median survival of 6 months, and a poorer prognosis if it has metastasized. We report a case of pancreatic cancer with metastasis to the liver, omentum and the breast which is extremely rare and seldom reported in literature. Case: A 51 y/o female with h/o HTN, DM, presented with c/o of yellowish discoloration of her skin and eyes, dark-colored urine and clay-colored stools for a period of two months. The jaundice was associated with abdominal pain, which was predominantly in the epigastrium, and LUQ, constant, sharp and not related to food intake. The symptoms were associated with 40 pounds unintentional weight loss in 3 months and weakness. Also the patient had noticed a mass in her left breast 3 months prior this presentation. Exam was notable for scleral icterus and yellowish discoloration of the tongue. Breast exam showed a firm mobile left breast mass in the upper outer quadrant. Abdominal exam showed mild distention, a palpable mass and tenderness in the epigastric region. Initial labs were remarkable for a LFT pattern consistent with obstructive jaundice. USG of abdomen showed dilatation of intra- and extra-hepatic biliary ducts. CT of the abdomen showed a cystic pancreatic mass with metastasis to the liver, omentum, involvement of mesenteric vessels, and obstruction of the CBD with intra- and extra-hepatic biliary dilatation. ERCP was done which revealed a mass in the pancreatic head, and a stricture in the CBD with a failed attempt at stent placement. The patient had two biopsies done; the first was a left breast Core biopsy which showed metastatic moderately differentiated adenocarcinoma. The tumor cells were positive for CK7, CK17, and CA19-9 and the immunostains for BRST-2, Mammaglobin, CK20 and CDX-2 were negative, favoring a pancreatic origin. The second was an omental biopsy which also showed metastatic moderately differentiated adenocarcinoma with necrosis and desmoplastic reaction. Immunochemistry was positive for CA19-9, MUC-1, CK17, CEA, CA125 and immunostains were negative for CDX-2. These immunohistochemical results in conjunction with the morphology favored a metastatic adenocarcinoma of pancreatic origin. Discussion: Pancreatic cancer usually metastasizes to the local lymph nodes, the peritoneum, or by hematogenous spread to the liver. Spread outside of these areas is extremely rare and is usually associated with multifocal disease. Although rarely reported in the literature, breast metastases from pancreatic carcinoma can occur and should be distinguished from primary breast cancer for appropriate management.

Phase IB Randomized, Double-Blinded, Placebo-Controlled, Dose Escalation Study of Polyphenon E in Women with Hormone Receptor–Negative Breast Cancer

Epidemiologic data support an inverse association between green tea intake and breast cancer risk, and numerous experimental studies have shown the antitumor effects of its main component, epigallocatechin gallate (EGCG). We conducted a phase IB dose escalation trial in women with a history of stage I to III hormone receptor-negative breast cancer of an oral green tea extract, polyphenon E (Poly E) 400, 600, 800 twice daily or matching placebo for 6 months. The primary endpoint was to determine the maximum tolerated dose (MTD), defined as the dose that causes 25% dose-limiting toxicity (DLT, grade ≥II). Assignment to dose level was based upon an adaptive design, the continual reassessment method. A mammogram and random core biopsy of the contralateral breast were obtained at baseline and 6 months and serial blood/urine collections every 2 months for biomarker analyses. Forty women were randomized: 10 to placebo, 30 to Poly E (16 at 400 mg, 11 at 600 mg, 3 at 800 mg). There was one DLT at 400 mg (grade III rectal bleeding), three DLTs at 600 mg (grade II weight gain, grade III indigestion and insomnia), and one DLT at 800 mg (grade III liver function abnormality). The DLT rate at 600 mg was 27% (3 of 11). Pharmacologic levels of total urinary tea polyphenols were achieved with all three dose levels of Poly E. Using a novel phase I trial design, we determined the MTD for Poly E to be 600 mg twice daily. This study highlights the importance of assessing toxicity for any chemopreventive agent being developed for chronic use in healthy individuals.

The value of examination of multiple levels of mammary needle core biopsy specimens taken for investigation of lesions other than calcification

AimsIt is a standard practice to examine multiple levels of needle core biopsies taken for mammographic calcification, but there is almost no evidence on the value of levels in core...

Reassessing Specimen Number and Diagnostic Yield of Ultrasound Guided Breast Core Biopsy

To reassess the minimum number of specimens required for an accurate diagnosis compared to the standard acquisition of five specimens. A total of 190 consecutive breast mass biopsies were performed using a 14-gauge core biopsy needle under ultrasound guidance. Two to six specimens were obtained from each mass and placed in sequential containers. Each specimen was evaluated by a pathologist in the order it was obtained and was labeled as "diagnostic' or 'non-diagnostic'. During the biopsy procedure, the radiologist indicated after which number biopsy he was confident that an adequate diagnostic specimen had been obtained. This was based upon real-time visualization of the needle passing through the lesion and whether the specimen sank or floated in formalin. These observations were compared with the pathologic diagnostic yield according to specimen number. Fifty-eight lesions (30.5%) were malignant, four (2.1%) were atypical, and 128 (67.4%) were benign. Histologic diagnosis was obtained after the first specimen in 157 (82.6%) lesions, the second specimen in 172 (90.5%) lesions, the third specimen in 186 (97.9%) lesions, the fourth specimen in 188 (98.9%) lesions, and the fifth specimen in 190 (100%) lesions. A histologic diagnosis was made in 90% of the malignant lesions after the first biopsy pass, 95% after the second pass, 98% after the third pass, and 100% after the fourth and fifth passes. Nine (4.7%) lesions showed discrepancy between the radiologist's confidence of diagnosis and pathologic diagnostic yield. Of these lesions, seven were benign and two were malignant. A diagnostic yield of 95% was obtained based on operator estimate of the minimum number of required core biopsies. A high diagnostic yield of 98% was achieved after three biopsy passes and 100% after five passes.

Pathologic Findings of Follow-up Surgical Excision for Lobular Neoplasia on Breast Core Biopsy Performed for Calcification

This study aimed to ascertain pathologic findings of surgical follow-up excision (FUE) on patients who had radiologic finding of calcifications and lobular neoplasia (LN) on core biopsy. Breast core biopsy specimens from 2006-2011 with a diagnosis of pure classic-type LN (lobular carcinoma in situ [LCIS] and atypical lobular hyperplasia [ALH]) with no history of invasive carcinoma (IC) or ductal carcinoma in situ (DCIS) were studied. Two hundred thirty-seven patients with the diagnosis of calcium on radiologic studies had FUE and were included in the study. Cases were divided into group 1 (pure ALH, n = 163) and group 2 (pure LCIS, n = 74). The interval between the core biopsy and FUE ranged from 0.2 to 7 months (mean, 1.5 ± 1.1 months). The risk of upstaging on FUE (DCIS or IC) is as follows: LCIS, 8.1% (6/74) and ALH, 3.1% (5/163). The data indicate that there is a low risk of upstaging to DCIS/IC from a core biopsy diagnosis of lobular neoplasia.

Variability of gene expression profile in breast cancer core biopsy: Impact on prognostic and predictive multigene signatures.

e21049 Background: Gene expression profiling has been shown to be effective in the analysis of postoperative tumor samples in breast cancer. However, when small specimens like core biopsy samples are considered, the small size of the collected material makes it difficult to obtain high tumor percentage in the specimen. Thus, we tested the strategy of obtaining three independent cores for molecular analysis and assessed the influence of the stability of different prognostic and predictive signatures. Methods: We prospectively collected breast core biopsies from 82 consecutive patients treated by pre-operative chemotherapy. In each patient, three cores from different tumor areas were sampled for molecular testing, independent of the cores collected for histopathological analysis. RNA was isolated by QIAGEN RNeasy kits, gene expression profiling was carried out using Affymetrix HG-U133 Plus 2.0 microarrays. Results: In 27 patients, three independent specimens were analyzed by microarray gene expression profiling (in total 81 samples). When this training set was analyzed by unsupervised Principal Component Analysis, the overall concordance between the three tumor cores was observed, but no such concordance was seen for three tumors (for each with one significant outlier). When we assessed the set of chosen 20 prognostic and predictive signatures, we confirmed that the homogeneity of gene expression within the signatures is significantly better than for random sets of genes, but we observed the notable differences between the signatures. The heterogeneity decreased when genes with low between-patient variance were excluded; they also showed a higher intra-patient variability of gene expression. We also assessed the heterogeneity of single expression markers and furher validated our findings on an independent set of 55 patients. Conclusions: The use of three independent cores for gene expression testing in breast cancer may be a successful strategy to overcome tumor heterogeneity and sampling error and result in more stable results of prognostic and/or predictive signatures. Supported by Polish National Science Center grant N402 6861 40

47P Free Hand Breast Core Biopsies in a Selected Group are as Good as Image Guided Biopsies

ABSTRACT Introduction There has been an increasing trend towards image guided core biopsy than free hand biopsy for symptomatic breast lesions. We aimed to study our own practice. Methods All patients presenting to one stop breast clinic needing core biopsies over an 18 month period under a single consultant were prospectively included in this study. Information was collected regarding method & number of biopsies, time delay between patient initial assessment, core biopsy and results given. Results 400 consecutive breast core biopsies were performed over this 18 month period. Table 1 . Free hand biopsy Image guided biopsy p value Total number (%) 304 (76%) 96 (24%) Median number of cores taken per biopsy (range) 2 (1-8) 4 (1-7) Median number of days lapsed between patient assessment and core biopsy (range) 0 (0-50) 8 (0-34) Median number of days lapsed between patient assessment and result given (range) 7 (2-52) 16 (2-44) Sensitivity 294/304 (96.7%) 95/96 (98.9%) 0.19 Cancer Ratio 1:1.1 1:2.5 0.04 Conclusions 76 % of biopsies have been performed free hand with no significant difference in diagnostic sensitivity compared with image guided biopsies. In a selected group, free hand biopsies provide the added advantage of early diagnosis and subsequent treatment. Disclosure All authors have declared no conflicts of interest.

Abstract 687: A comparative study of p95-HER2 carboxy terminal fragment (CTF) detected by immunohistochemistry and VeraTag assays in human breast tumors

Abstract C-terminally truncated forms of HER2 (HER2-CTF) have been reported to be highly oncogenic and correlate with node-positive breast cancer, poor prognosis, and attenuated response to trastuzumab in patients with HER2+ metastatic breast cancer (MBC). A quantitative, sensitive and specific immunoassay using the VeraTag™ technology has been developed to detect the active Met611-HER2 CTF (p95) in FFPE tumor samples and has been used to identify HER2+ MBC patients who have a reduced response to trastuzumab in two independent cohorts. Recently, an IHC assay using an antibody directed to a similar p95 epitope was reported to detect a high percentage of HER2+ samples (79%) as p95 positive (#530, ASCO 2011). To verify the cellular specificity and accuracy of the VeraTag p95 assay, and evaluate the prevalence of p95 in breast tumors, an IHC assay was developed which utilizes the same p95 antibody as the VeraTag assay. The IHC and VeraTag assay formats were compared in 120 human breast tumor excisional and core biopsy samples submitted to central clinical reference lab testing, and having different levels of HER2 measured by HercepTest IHC: 0 (n=20); 1+ (n=20), 2+ (n=20), and 3+ (n=60). Replicate slides were run in both VeraTag and IHC assays to demonstrate reproducibility. Nearly all p95 IHC signal was associated with tumor cells only. Consistent with earlier VeraTag p95 data, a general correlation was observed between p95 and HER2 levels, with tumors expressing normal levels of HER2 rarely expressing high p95 levels. However, within the subset of HER2+ samples (IHC 3+ or FISH &amp;gt; 2.2; n=63), a ∼30-fold range of p95 VeraTag signal was observed, with 44% having p95 expression above the level of a previously determined clinical cutoff for trastuzumab response (Clin Cancer Res 16: 4226 2010). A similar relationship was observed for samples assayed by p95 IHC. All samples measured as p95 IHC 3+ (&amp;gt;10% cells with 3+ membranous staining) were HER2+ by central lab testing and represented nearly a third of the HER2+ samples. The VeraTag p95 assay generally agreed with p95 IHC scored by test category 0-3+ (r=0.54; p&amp;lt;0.0001) or histoscore (r=0.54; p&amp;lt;0.0001) with 79% of the p95 IHC 3+ samples falling above the p95 VeraTag assay clinical cutoff. Fewer p95 VeraTag positive samples were represented in p95 IHC 2+ and 1+ categories. These results indicate that the tumor-specific p95 signal detected by the p95 VeraTag assay is in general agreement with an IHC assay using the same antibody; however a number of cases with p95 VeraTag scores above the clinical cutoff do not fall into the p95 IHC 3+ category. Additionally, the prevalence of p95 positivity by VeraTag assay and by IHC 3+ scores is consistent with earlier peer-reviewed studies and lower than recently reported using a different IHC assay. The clinical significance of using the p95 IHC assay to complement the VeraTag p95 score is being evaluated. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 687. doi:1538-7445.AM2012-687

Is mode of presentation (screening or symptomatic) a distinguishing factor in the pathology of B3 core biopsies?

Introduction: The relationship between pathological subtype and mode of presentation (screening vs. symptomatic) of breast core biopsies classified as probably benign (B3) has not been examined before. We hypothesise that papillary and fibroepithelial lesions would be more highly represented in symptomatic patients (more often palpable). In contrast, we expect that atypia, lobular neoplasia and sclerosing lesions would be more common amongst screening (distinct mammographic appearances).

Audit of B3 diagnosis in breast core biopsy: Evaluation of positive predictive value, sufficiency of tissue volume and compliance with minimum dataset

Introduction: Needle core biopsy is the routine biopsy method in the diagnosis of breast lesions. A number of lesions are classified as B3 uncertain malignant potential, according to the NHS Breast Screening Programme (NHSBSP). These lesions pose considerable clinical challenge as a proportion will prove malignant on excision. This study aims to estimate the PPV of B3 diagnosis at this Trust, to compare it to that described in the literature, to assess whether a greater breast tissue volume at biopsy would increase the likelihood of definitive diagnosis and to assess compliance with RCPath minimum dataset.

99 Free Hand Breast Core Biopsies in a Selected Group Are as Good as Image Guided Biopsies

99 Free Hand Breast Core Biopsies in a Selected Group Are as Good as Image Guided Biopsies