Core Needle Biopsy Diagnosis Research Articles

Role of percutaneous needle core biopsy in diagnosis and clinical management of renal masses.

Percutaneous needle core biopsies are routinely performed for renal mass diagnosis in some institutions. Because of limited tissue availability, accurate diagnosis can be challenging, and the role of needle core biopsy (NCB) remains debatable in kidney tumor management. In the present study, we reported our experience in diagnosing renal masses via percutaneous NCB and the role it plays in clinical management of these masses. We studied 301 consecutive cases of percutaneous NCBs performed for 280 renal masses from 269 patients between year 2008 and 2011 by reviewing final pathology diagnosis, hematoxylin and eosin slides, and ancillary studies. Diagnostic accuracy was determined by comparing biopsy and nephrectomy diagnoses in a subset of renal masses. Clinical data including demographic information, clinical presentation, radiographic findings, and treatment information were reviewed subsequently if available. The size of renal masses in our study cohort ranged from 0.5 to 24 cm, and 78% of them were small renal masses. Definite diagnoses were rendered in 89% of the renal masses by NCBs, and 23% of them were benign. Renal mass NCB was 100% accurate in diagnosing primary renal malignancy and 93% accurate in determining histologic subtypes. Clinical management was analyzed for 180 renal masses. There was significant difference in clinical management between different diagnostic groups. We conclude that percutaneous NCB is a powerful tool not only for definite tissue diagnosis of renal masses before treatment but also plays an important role in guiding patient management and obtaining material for future molecular studies for targeted therapies.

Predicting the biologic classification of phyllodes tumors from preoperative core needle biopsy and imaging findings.

86 Background: Phyllodes tumors (PT) are rare breast neoplasms confounding their systematic study and evidence-based management guidelines. There is little data on the sensitivity of preoperative core needle biopsy (CNB) and imaging findings in establishing a correct preoperative diagnosis. We undertook this study to evaluate the sensitivity of CNB histologic findings and imaging findings in preoperatively categorizing tumors as benign or borderline/malignant. Methods: We identified 47 patients who underwent surgical resection of a PT at our institution after a preoperative CNB between 6/2000-3/2012. Statistical analysis utilized Wilcoxon rank-sum, chi-square or Fisher’s exact tests, and 95% confidence intervals (CI) are reported. Results: 30 patients had a final diagnosis of benign and 17 of borderline/malignant PT. The latter were significantly more often palpable (76.5% vs 36.7%, p=0.01). No other clinical or radiologic feature predicted borderline/malignant subtype, although irregular shape on US was suggestive (70.6% vs 44.8%, p= 0.09). CNB diagnosis by tumor type is summarized in the table. No benign PT had ≥10 mitoses, necrosis or marked stromal atypia on CNB. No case with absent mitoses on preoperative CNB was a borderline/malignant PT; however 77% of benign PT did exhibit mitoses on CNB. Sensitivity of CNB for PT overall was 48.9% (95% CI: 35.3-62.8%) while it was 40% (24.6-57.7%) for benign PT and 17.6% (6.2-41.0%) for borderline/malignant PT. Conclusions: Marked stromal atypia, ≥10 mitoses and necrosis were rare on CNB, but suggestive of malignancy. No imaging or histology feature reliably distinguished between tumor types. Over one-third of borderline/malignant PT had a preoperative CNB diagnosis of fibroadenoma or cellular fibroepithelial lesion emphasizing the low sensitivity of CNB and the need for judicious consideration of definitive surgical excision. [Table: see text]

Grading of breast cancer on needle core biopsy: does a reduction in mitotic count threshold improve agreement with grade on excised specimens?

BackgroundAccurate assessment of invasive breast cancer grade on needle core biopsy (NCB) is important as it guides treatment.AimTo assess the agreement between grade of invasive cancer on NCB and excision...

Abdominal ultrasound-guided transvaginal myometrial core needle biopsy for the definitive diagnosis of suspected adenomyosis in 1032 patients: a retrospective study.

To assess the results of abdominal ultrasound-guided transvaginal myometrial core needle biopsy (CNB) for the definitive diagnosis of adenomyosis. Retrospective study (Canadian Task Force classification II-3). Private practice. A total of 1032 consecutive premenopausal women aged 22 to 53years who had undergone myometrial CNB and uterine-preserving surgery to treat adenomyosis, which was preliminarily diagnosed on the basis of symptoms and ultrasonographic findings. Transvaginal myometrial CNB under abdominal ultrasound guidance. The mean age of the 1032 patients was 41.4years (range, 22-53years); 61% were aged 40 to 49years, and 33% were aged 30 to 39years. The mean Pictorial Blood Loss Assessment Chart (PBAC) score was 271.1, and total pain score was 11.79. The mean anterior myometrial thickness was 2.79cm (range, 0.7-8.7cm), and the posterior myometrial thickness was 3.72cm (range, 1.1-9.4cm). A total of 2596 myometrial tissue cores were obtained from thickened myometrium via abdominal ultrasound-guided transvaginal myometrial CNB. At histopathologic examination the tissue cores demonstrated adenomyosis in 2167, myometrial hypertrophy in 343, and leiomyoma in 86. Patients were classified into a concordant group (adenomyosis only, adenomyosis plus hypertrophy, and adenomyosis plus leiomyoma; n=951) and a discordant group (hypertrophy and leiomyoma; n=81), depending on conformance between the pathologic result and the preliminary ultrasonographic diagnosis. The study showed a 92.26% concordance rate of adenomyosis between the transvaginal myometrial CNB and ultrasonographic diagnoses. The mean number of tissue cores in the discordant (n=2.12) and concordant (n=2.55) groups differed significantly (p<.05). Abdominal ultrasound-guided transvaginal myometrial CNB can be used in the definitive diagnosis of clinically and/or sonographically suspected adenomyosis in patients undergoing uterine-preserving surgery. Future research should focus on improving the definitive diagnostic rate of adenomyosis by using transvaginal myometrial CNB.

Breast Cytology: Current Issues and Future Directions

Breast cytology, in particularly fine needle aspiration biopsy (FNAB), has been used for many years as a diagnostic tool for managing patients with breast lesions. In experienced hands, FNAB is highly sensitive and specific. Other benefits include its low cost, minimal invasiveness, and ability to provide same-day diagnosis. Despite all these benefits, FNAB has gradually been replaced by core needle biopsy (CNB) because of its high error rates when there is a lack of experienced cytopathologists, its inability to distinguish between invasive and in situ carcinoma, and most importantly, its inability to provide adequate and suitable materials for quantitative evaluation of HER2 and other prognostic markers. Other uses of breast cytology include touch preparation cytology for intraoperative evaluation of sentinel lymph nodes and surgical margins of lumpectomy specimens and for providing same-day diagnosis of CNB. In addition, breast cytology, such as ductal lavage and nipple fluid cytology, has also found applications in risk assessment for women at high risk for developing breast cancer. With the increased utilization of molecular technologies, genomic and proteomic studies have been successfully applied to breast cytologic preparations. It would not be far fetched to predict that in the very near future, the clinical application of molecular analyses will be routine ancillary testing in breast cytology, thus allowing early cancer detection, and improved tumor characterization as well as prediction of patients' outcomes and therapeutic responses.

The role of core needle biopsy in the preoperative diagnosis of follicular neoplasm of the thyroid

Follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) can often be challenging to diagnose using core needle biopsy (CNB) specimens. We have developed the histologic criteria for the CNB diagnosis of FN and validated the usefulness of CNB. We retrospectively reviewed 184 CNBs and 224 FNACs diagnosed with FN/SFN. CNBs were histologically classified into four subgroups, based on the histologic features of follicular proliferation, fibrous capsulation, and surrounding parenchyma. Among 184 CNBs, 103 (55.9%) had previous FNAC results of non-diagnostic or indeterminate. Overall malignancy rates in FNAC (48%) and CNB (46%) were nearly identical (p>0.05), and the neoplasm rate was higher in CNB (88%) than FNAC (74%) (p=0.007). There was no significant difference in the malignancy rates among the four histologic subgroups. Among the 40 nodules with simultaneous CNB and FNAC, only nine had the FNAC diagnosis of FN/SFN, and others were non-diagnostic, benign, or atypia of undetermined significance. Overall, CNB improved specimen adequacy and achieved better sensitivity of the FN/SFN diagnosis in thyroid nodules that were inconclusive by FNAC. In the preoperative diagnosis of FN/SFN, CNB has no advantage over FNAC in predicting the likelihood of malignancy, but helps to reduce the need for repeat biopsy.

Clinicopathological significance of ‘atypical ductal proliferation’ in core needle biopsy of the breast

Atypical ductal proliferation or ADP has been used in histopathological diagnosis of core needle biopsy (CNB) but its details have not been well studied. Therefore, we examined the clinicopathological characteristics of the initial CNB cases diagnosed as 'ADP ' who subsequently turned out to be malignant, and compared the findings to those that did not. Among 101 cases initially diagnosed as ADP in CNB, the second biopsy revealed no carcinoma (38), ductal carcinoma in situ (DCIS) (45) and invasive carcinoma (18). Significant differences were detected between those which turned out to be carcinoma and those that did not, in the status of myoepithelial cells identified by p63 immunohistochemistry (P = 0.026) and ultrasound (US) categories (P < 0.001). We further compared the histopathological characteristics of those initially diagnosed as ADP and subsequently as DCIS or invasive ductal carcinoma (IDC) with those initially diagnosed as such. DCIS or IDC cases initially diagnosed as ADP had significantly lower Ki67 labeling index (P < 0.01, P < 0.01) and histological grade using Van nuys prognostic index (P < 0.01) or Nottingham histological grades (P < 0.01) respectively than those initially as DCIS or IDC. An assessment of myoepithelial components with US findings might contribute to determine the subsequent clinical algorithm of the patients diagnosed as ADP at initial CNB.

Computed tomography-guided core needle biopsy of lung lesions: Diagnostic yield and correlation between factors and complications

The aim of the present study was to determine the diagnostic accuracy of computed tomography (CT)-guided core needle biopsy (CNB) and to retrospectively analyze the correlation between the factors and complications of the procedure. Between January 2009 and June 2010, CNB was performed on 345 lung lesions in 343 patients. These patients were then followed up for at least two years. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the CNB diagnoses were calculated. The correlation between factors, such as smoking, positoin and maximal diameter, and the complications of pneumothorax and hemorrhage was analyzed by χ2 test. The sensitivity, specificity, accuracy, PPV and NPV of the CNB diagnoses were 97.3, 100, 97.7, 100 and 87.7%, respectively. A statistically significant correlation was found between pneumothorax and the factors of smoking (P=0.015) and position (P<0.01) and length of the needle in the normal parenchyma (P=0.011), as well as between hemorrhage and the maximal diameter (P=0.005) and length of the needle in the normal parenchyma (P<0.01) and the frequency of needle adjustments (P<0.01). A CT-guided core needle biopsy of the lung lesions provides a high diagnostic yield. Smoking, the decubitus position and a longer length of the needle in the normal parenchyma were found to represent risk factors for a pneumothorax. In addition, a small diameter and longer length of the needle in the normal parenchyma and a more frequent adjustment of the needle were poor predictive factors of hemorrhage.

Diagnostic benefits and cost‐effectiveness of on‐site imprint cytology adequacy evaluation of core needle biopsies of bone lesions

Core needle biopsy (CNB) is a well-established, successful technique for the diagnosis of various organ system lesions. To increase diagnostic yield, on-site cytologic evaluation of adequacy (OCA) is routinely performed at many institutions. Numerous studies evaluating the impact of OCA on CNB have been published. However, little has been said regarding accuracy of OCA for bone lesions. To evaluate this, we reviewed our experience during a two-year period, and compared OCA results with the final diagnosis of the corresponding CNB. For the study, diagnoses were divided into three categories: malignant, benign, and nonspecific/nondiagnostic findings. Sixty-one cases were included. During OCA, 25 cases were diagnosed as malignant, three cases as benign, and 33 as nonspecific/nondiagnostic. On histologic evaluation, 29 cases were malignant, 16 were benign, and 16 were classified as nonspecific/nondiagnostic. Concordance with final CNB diagnosis was seen in 100% of malignant, 67% of benign, and 45% of nonspecific/nondiagnostic on-site cytology evaluations. The overall diagnostic success rate of OCA for malignancy was 86% (25/29). The success rate of OCA for benign lesions was only 13%. Fifty-four percent of cases were diagnosed as nonspecific/nondiagnostic on-site. This category included four false negative cases. We conclude that for lesions with a suspicion of malignancy, OCA is a valuable adjuvant diagnostic tool. However, for cases with a benign or nonspecific clinical impression, OCA has a limited diagnostic role. Careful selection of cases in which OCA is beneficial is necessary to maintain accuracy and to limit procedure costs.

Ultrasound-guided core needle biopsy in diagnosis of abdominal and pelvic neoplasm in pediatric patients

Ultrasound-guided core needle biopsy of abdominal and pelvic masses in adults has gained tremendous popularity. However, the application of the same treatment in children is not as popular because of apprehensions regarding inadequate tissues for the biopsy and accidental puncture of vital organs. Data of the application of ultrasound-guided core needle biopsy in 105 pediatric patients with clinically or ultrasound-diagnosed abdominopelvic masses were reviewed. Diagnostic procedures were conducted in our institution from May 2011 to May 2013. The biopsies were conducted on 86 malignant lesions and 19 benign lesions. 86 malignant tumors comprised neuroblastomas (30 cases), hepatoblastomas (15 cases), nephroblastomas (11 cases), and primitive neuroectodermal tumors/malignant small round cells (6 cases). Among malignant tumor cases, only a pelvic primitive neuroectodermal tumor did not receive a pathological diagnosis. Therefore, the biopsy accuracy was 98.8 % in malignant tumor. However, the biopsies for one neuroblastomas and one malignant small round cell tumor were inadequate for cytogenetic analysis. Therefore, 96.5 % of the malignant tumor patients received complete diagnosis via biopsy. 19 benign tumors comprised mature teratoma (10 cases), hemangioendothelioma (3 cases), paraganglioma (2 cases), and infection (2 cases). The diagnostic accuracy for benign neoplasm was 100 %. Five patients experienced postoperative complications, including pain (2 patients), bleeding from the biopsy site (2 patients), and wound infection (1 patient). Ultrasound-guided core needle biopsy is an efficient, minimally invasive, accurate, and safe diagnostic method that can be applied in the management of abdominal or pelvic mass of pediatric patients.

Abstract B114: Core biopsy in breast cancer diagnosis: The provincial evaluation of utilization and relationship with treatment outcomes

Abstract Purpose:To determine: 1) The proportion of women in British Columbia (BC) who have a pre-operative diagnosis of breast cancer by image-guided core biopsy; 2) Whether women who have a pre-operative radiological diagnosis of breast cancer with core biopsy have fewer breast surgeries as part of their initial therapy; 3) Whether local/ locoregional relapse is lower in women who have had a pre-operative diagnosis of breast cancer with a core biopsy versus an open biopsy; 4) Whether there is regional variation in the use of pre-operative core biopsies versus open biopsies in the diagnosis of breast cancer in B.C. 5) Whether the risk of pN0i+ on sentinel node biopsy (SNB) is reduced when the initial diagnosis of breast cancer is made on core biopsy versus open biopsy. Methods: All B.C residents diagnosed with breast cancer in 2006 were reviewed. The women were divided into groups according to the method of diagnosis- pre-operative core needle biopsy, operative biopsy (open biopsy or other surgery), versus other diagnosis. Core biopsies were further divided into image-guided versus clinically-directed core. Women with denovo metastatic disease, locally advanced disease, prior or synchronous invasive or insitu breast cancer, Paget's, alone or with insitu disease, patients with surgical procedures performed out of province, patients diagnosed on death certificate/ autopsy only, and cases without pathology were all excluded. Results: 3130 patients diagnosed in 2006 were identified in the BC Cancer Agency Registry. After exclusions, 2589 patients were included in the study cohort. 32% of patients had diagnosis made on an open surgical procedure, and 68% were diagnosed on a non-open biopsy, of which, 80% were image-guided core biopsies. Seventy-five percent of women with an image-guided core had one or less surgical procedure compared to only 26% of women whose diagnosis was made by surgery, despite the image-guided core biopsy group having larger, more invasive tumors and increased nodal positivity. The type of biopsy did not impact the prevalence of pN0i+ on SNB, or local and locoregional relapse rate. Regionally, Vancouver Coastal and Vancouver Island Health Authority, which are more densely populated urban centres, had the highest proportion of patients diagnosed by core biopsy, 70.3% and 75.4% respectively, and the sparsely populated Northern Health Authority had the lowest proportion at 46.7%. Conclusions: Core biopsies for breast cancer diagnosis are under-utilized in British Columbia and show significant regional variation. Although core biopsy diagnosis does not impact rate of pN0i+ on nodal biopsy or locoregional relapse rates, it is associated with substantially fewer breast/nodal surgeries. More resources are required to promote the use of CNB to providers and patients. Citation Format: Kristy KM Cho, Christine Wilson, Scott Tyldesley, Caroline Speers. Core biopsy in breast cancer diagnosis: The provincial evaluation of utilization and relationship with treatment outcomes. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Breast Cancer Research: Genetics, Biology, and Clinical Applications; Oct 3-6, 2013; San Diego, CA. Philadelphia (PA): AACR; Mol Cancer Res 2013;11(10 Suppl):Abstract nr B114.

Using Machine Learning to Identify Benign Cases with Non-Definitive Biopsy.

When mammography reveals a suspicious finding, a core needle biopsy is usually recommended. In 5% to 15% of these cases, the biopsy diagnosis is non-definitive and a more invasive surgical excisional biopsy is recommended to confirm a diagnosis. The majority of these cases will ultimately be proven benign. The use of excisional biopsy for diagnosis negatively impacts patient quality of life and increases costs to the healthcare system. In this work, we employ a multi-relational machine learning approach to predict when a patient with a non-definitive core needle biopsy diagnosis need not undergo an excisional biopsy procedure because the risk of malignancy is low.

Prospective Multicenter Trial Evaluating Balloon-Catheter Partial-Breast Irradiation for Ductal Carcinoma in Situ

To determine outcomes of accelerated partial-breast irradiation (APBI) with MammoSite in the treatment of ductal carcinoma in situ (DCIS) after breast-conserving surgery. We conducted a prospective, multicenter trial between 2003 and 2009. Inclusion criteria included age >18 years, core needle biopsy diagnosis of DCIS, and no prior breast cancer history. Patients underwent breast-conserving surgery plus MammoSite placement. Radiation was given twice daily for 5 days for a total of 34 Gy. Patients were evaluated for development of toxicities, cosmetic outcome, and ipsilateral breast tumor recurrence (IBTR). A total of 41 patients (42 breasts) completed treatment in the study, with a median follow up of 5.3 years. Overall, 28 patients (68.3%) experienced an adverse event. Skin changes and pain were the most common adverse events. Cosmetic outcome at 6 months was judged excellent/good by 100% of physicians and by 96.8% of patients. At 12 months, 86.7% of physicians and 92.3% of patients rated the cosmetic outcome as excellent/good. Overall, 4 patients (9.8%) developed an IBTR (all DCIS), with a 5-year actuarial rate of 11.3%. All IBTRs were outside the treatment field. Among patients with IBTRs, the mean time to recurrence was 3.2 years. Accelerated partial-breast irradiation using MammoSite seems to provide a safe and cosmetically acceptable outcome; however, the 9.8% IBTR rate with median follow-up of 5.3 years is concerning. Prospective randomized trials are necessary before routine use of APBI for DCIS can be recommended.

Ultrasound‐guided core needle biopsy of salivary gland lesions: A systematic review and meta‐analysis

To obtain summary estimates of the sensitivity and specificity of core needle biopsy for assessment of salivary gland lesions and to investigate sources of variation in accuracy between study locations. Data sources were PubMed, Embase, CAB Abstracts, CINAHL, BIOSIS, LILACS, PakMediNet, Trip Database, and the National Guideline Clearinghouse. Scopus was used to perform forward (citation) and backward (reference) searches of all potentially relevant studies. Screening, data extraction, and quality assessment were independently performed by two different assessors. Meta-analysis was performed using bivariate mixed-effects binary regression as implemented in Stata 12. Quality assessment was performed using the QUADAS-2. The summary estimates of sensitivity and specificity of core needle biopsy for diagnosis of malignancy were 96% (95% confidence interval [CI] = 87-99) and 100% (95% CI = 84-100), respectively. There was no significant heterogeneity in accuracy between studies. The quality of included studies was high, with low risk of verification bias. The risk of hematoma was 1.6% per procedure. Core needle biopsy has high sensitivity and specificity, and has low risk of complications. There is no significant variation in accuracy between study locations.

Flat Ductal Intraepithelial Neoplasia 1A Diagnosed at Stereotactic Core Needle Biopsy: Is Excisional Biopsy Indicated?

This study correlates ductal intraepithelial neoplasia (DIN) 1A diagnosed at stereotactic spring core needle biopsy (CNB) or vacuum-assisted biopsy (VAB) with the subsequent surgical histologic results or long-term follow-up imaging findings to predict the likelihood of upgrade to ductal carcinoma in situ (DCIS) or invasive carcinoma. Stereotactic imaging-guided CNBs and VABs were performed principally for assessment of microcalcifications seen on mammography. DIN 1A diagnoses made at CNB or VAB were correlated with subsequent excisional biopsy results or imaging follow-up. Patients were included only if there was no concomitant CNB or VAB diagnosis of DIN 1B, atypical lobular hyperplasia, lobular carcinoma in situ or DCIS, papillary lesion, or invasive carcinoma. Surgical biopsy results were obtained for 239 patients. Upgrade was defined as a diagnosis of DCIS or invasive carcinoma at surgery. Patients who did not undergo surgical excision were followed with imaging. An upgrade rate of 4.2% (10 lesions in 239 patients) is reported. The remaining samples (229/239) had a surgical diagnosis of DIN 1A or DIN 1B, lobular carcinoma in situ, or a benign finding with no atypia. The upgrade rate of DIN 1A diagnosed at CNB or VAB was 4.2%. These results indicate it may be reasonable to avert immediate surgery in favor of short-term imaging follow-up.

Value of Computed Tomography–guided Core Needle Biopsy in Diagnosis of Primary Pulmonary Lymphomas

PurposeTo evaluate the value of computed tomography (CT)–guided core needle biopsy in diagnosis of primary pulmonary lymphoma and its subtypes. Materials and MethodsA retrospective analysis of the records of all patients with primary pulmonary lymphoma between January 2005 and August 2011 was performed. There were 25 patients referred to the radiology department for CT-guided core needle biopsy. The success rate and complications were assessed. ResultsA definitive diagnosis and accurate histologic subtype were obtained in 21 patients with a success rate of 84.0%. Diagnosis was made in the other four patients with bronchoscopy and surgery. Non-Hodgkin lymphoma (NHL) was the diagnosis in all patients. Most subtypes were mucosa-associated lymphoid tissue (MALT) lymphomas (n = 19). The remaining subtypes included three diffuse large B-cell NHLs, two peripheral T-cell lymphomas not otherwise specified, and one anaplastic large cell NHL. The success rate of core needle biopsy was 95% (18 of 19) for MALT lymphomas, 67% (2 of 3) for diffuse large B cell NHLs, and 33% (1 of 3) for other NHLs. The success rate for MALT lymphomas was significantly higher than that of non-MALT lymphomas according to Fisher exact t test (P = .031). No serious complications occurred in any patients. ConclusionsCT-guided core needle biopsy is a reliable procedure to assist in diagnosis and classification of primary pulmonary lymphomas, especially MALT lymphomas.

Incidence of Breast Cancer in Patients with Pure Flat Epithelial Atypia Diagnosed at Core-Needle Biopsy of the Breast

to determine the frequency of malignancy in subsequent breast excisions following core-needle biopsy (CNB) diagnosis of pure flat epithelial atypia (pFEA) and to evaluate the imaging features of the associated tumors. Retrospective review of 8,996 image-guided CNB (2002-2010) identified 115 cases of FEA not associated with other atypia. Patients with history of breast cancer or radiation therapy were excluded. One hundred four cases (women) with pFEA (mean age 51 years, range 29-77 years) were reviewed. Stereotactic CNB was performed in 79 (76%) cases and ultrasound (US)-guided CNB in 25 (24%) cases. In 99 cases 14G needles were used, and 10G vacuum-assisted devices were used in 5 cases. Ninety-four patients had subsequent excision. Ten patients declined excision, and imaging follow-up (mean of 36 months) is available. The upgrade rate of pFEA was defined as the number of patients diagnosed with invasive carcinoma (IC) or carcinoma in situ (CIS) divided by the total number of patients. 10 of 104 (9.6%) patients were diagnosed with cancer: 9 presented as calcifications (89% fine pleomorphic and amorphous) and 1 case as a mammographically occult mass. The size of calcifications was not statistically significant (P=0.358). Five cases had ductal carcinoma in situ (DCIS) and five cases had IC (ductal and lobular) presenting as amorphous and pleomorphic calcifications. The upgrade rate of pFEA in our series was 9.6%. The presence of 4.8% of invasive cancers is substantial and warrants continuing management with surgical excision in all cases.

Accuracy of percutaneous core needle biopsy in diagnosing papillary breast lesions and potential impact of sonographic features on their management

To assess retrospectively the accuracy of core needle biopsy in diagnosing papillary breast lesions and evaluate the prediction of malignant papillary lesions based on sonographic features. Review of 130 papillary lesions diagnosed on core needle biopsy (2002-2008) in 110 patients. The biopsy results were compared with final surgical pathology or evolution on imaging follow-up. Lesion size, patient age, type of biopsy needle and guidance, and length of imaging follow-up were documented. Sonographic features were retrospectively reviewed according to the BI-RADS lexicon. Morphology, not part of BI-RADS, was assessed as intraductal, intracystic, or solid. Of the 130 papillary lesions, 6 were sampled with an 11-G vacuum-assisted needle under stereotactic guidance and the remaining 124 were sampled under US guidance with a 14-G (n = 115), 18-G (n = 8), or 10-G (n = 1) needle. Initial core needle biopsy diagnosis was benign (n = 103), showed atypia (n = 20), or malignancy (n = 7). Thirty-seven (36%) benign lesions were surgically excised and 66 (64%) were followed up. On final outcome, 10 benign lesions were upgraded to malignancy (9.7%) and 3 to atypia (3.6%). There was no significant difference in the benign, malignant, and upgraded groups with respect to size, age, or BI-RADS sonographic characteristics. None of the oval-shaped lesions nor the intraductal ones were upgraded. Although some sonographic features could favor a benign diagnosis, when a core biopsy yields the diagnosis of a papillary lesion, surgical excision is recommended to definitely exclude malignancy.

1316 - Feasibility and Usefulness of Determining EGFR and KRAS Mutations in Cytological Samples and CNB of NSCLC Using an Automated Real-Time PCR System

ABSTRACT Background EGFR and KRAS gene mutations guide treatment selection in non-small cell lung cancer (NSCLC) patients. About 70%-80% of these patients are diagnosed at advanced stage, and mutational analysis has to be performed in small samples: core needle biopsy (CNB) and fine needle aspiration (FNA) cytology. Cobas® EGFR Mutation Test has been CE-IVD marked for the detection of 41 mutations in formalin-fixed-paraffin-embedded (FFPE) NSCLC specimens. No validation studies have been performed using cytological samples. Determining the feasibility of cobas® test on such samples is an important step to extend the benefits of molecular targeted therapy. Methods EGFR and KRAS mutations were studied in 64 non-selected samples from NSCLC patients: 31 CNB and 33 FNA. DNA was extracted directly from stained smears in FNA samples and from 4-micron sections in CNB. All samples contained at least 50% of tumor cells. All cases were studied using the cobas® test, and FNA samples were also analyzed by direct sequencing. DNA was extracted using the cobas® DNA Sample Preparation Kit. DNA concentration and DNA ratio of sample absorbance at 260/280nm (A260/280) were registered. U Mann Whitney test was used. Results CNB diagnosis was: 23 SqCC, 6 AC, 1 BAC, and 1 NSCLC-NOS. FNA diagnosis was: 26 AC, 3 SqCC, 1 BAC, 1 LCC, and 2 NSCLC-NOS. Mean DNA concentration from CNB was 23.07ng/ul ± 20.99, and from FNA samples 12.41ng/ul ± 20.04 (p Table 1 . Sanger sequencing in all FNA cases rendered concordant results. Updated results will be presented. FNA CNB EGFR WT 6 28 EXON 19 DEL 2 1 EXON 20 INS 0 1 INVALID 1 1 KRAS WT 9 26 12/13 MUTATED 9 4 INVALID 1 1 Conclusions Assessment of EGFR and KRAS mutations in FNA and CNB samples using cobas® EGFR and KRAS test is feasible and reliable. Quality of DNA (A260/280) using cobas® DNA Sample Preparation Kit in FNA samples is similar to those from CNB. Molecular results from FNA samples using cobas® test and direct sequencing are concordant, though cobas® tests are simpler, faster and easier to use. Disclosure All authors have declared no conflicts of interest.

Salivary gland carcinomas

Salivary gland carcinomas are rare tumours of heterogeneous morphology that require distinctive surgical and adjuvant therapy. Relevant studies were electronically searched in PubMed and reviewed for innovative and important information. Recent insights in genetic alterations like chromosomal aberrations, expression of receptor tyrosine kinases, malfunction of tumour suppressor genes or DNA promoter methylations increased the knowledge about aetiology and pathogenesis. New histological subtypes are recognised, and a three-tiered grading system seems reasonable. Ultrasound remains the basic diagnostic imaging procedure. New developments comprise the diffusion-weighed magnetic resonance imaging, while fluorodeoxyglucose positron emission tomography/computed tomography shows good diagnostic accuracy in detecting distant metastases and local recurrence. Fine-needle aspiration cytology helps in differentiating a neoplasia from a non-neoplastic lesion while being unreliable in recognising malignancy. In contrast, additional core needle biopsy and/or intraoperative frozen section diagnosis increase the accuracy in diagnosing a malignant lesion. Conservative parotid surgery with nerve monitoring remains state-of-the-art. Free flaps or musculoaponeurotic flaps are proposed for prevention of Frey's syndrome. As parotid cancer often shows skip metastases, complete ipsilateral neck dissection (level I-V) is indicated particularly in high-grade lesions. Adjuvant radio(chemo)therapy increases local tumour control, whereas overall survival is not necessarily improved. Current results of systemic chemotherapy or targeted therapy in advanced tumour stages are disappointing. Despite several developments, salivary gland carcinomas remain a heterogeneous group of tumours challenging both pathologists and clinicians.