Intraductal Papilloma Research Articles

The cut-off value of ADC to differentiate benign from malignant breast lesions

Background: Diffusion-weighted MRI is a fast, unenhanced modality that shows promise in identifying mammographically occult malignancy and warrants further investigation as an alternative supplemental breast cancer screening tool.Aim of study: To estimate the diagnostic accuracy of diffusion wighted imaging and apparent diffusion coeffient (ADC) value in the differentiation between benign and malignant breast lesions, and to obtain a cutoff ADC value between benign and malignant breast lesions along with histopathological correlation. Materials and Methods: A prospective study of 56 patients with present with breast mass who examined at 1.5 tesla MRI & proved by histopathology. ADC value were a quired at b values of 0, 600, 850 s/mm² after identification of ROI (Region of interest) placement. ADC value with histopathology correlation was analyzed. Results: From total 56 lesions, 24 lesions were histologically malignant and 32 were histologically benign. With an ADC cut‑off value of 1.31 × 10−3 mm2/s for malignant lesions, a sensitivity of 100% and specificity of 72.1% was obtained. The false‑postive lesions were one intraductal papilloma & 3 abcesses in which a low ADC value was obtained. Purely DCIS (Ductal carcinoma in situ) lesions presenting as non‑mass‑like enhancement had a high ADC value of 1.2‑1.3 × 10−3 mm2/s, thereby decreasing specificity. Conclusion: Diffusion‑weighted Imaging is a functionl quantitative assessment by ADC value, may act as an efficient tool in increasing the diagnostic accuracy and specificity of breast MRI in the characterization of different breast lesions.

Comparison of diagnostic efficacy of ultrasound, ultrasound elastography and magnetic resonance imaging for breast lesions

Study aimed to evaluate and compare the performance of ultrasound, ultrasound elastography and magnetic resonance imaging in the diagnosis of breast cancer & its differentiation from benign lesions Material & Method: This cross-sectional observational study was conducted at department of Radiodiagnosis, Era’s Lucknow Medical college. The study was conducted for 18 month from January 2019 to june 2020. Patients detected with breast lesions and willing to be part of study were included in the study. The patients with cystic nodules and non-consenting patients were excluded from the present study. All the patients were subjected to B-mode USG assessment followed with Real Time ultrasound Elastography and 0.5 Tesla MRI scan. Fine needle aspiration cytology (FNAC) or biopsy was performed and the specimen were evaluated cytologically/histopathologically to confirm the diagnosis Result: Histopathologically, 18 (36%) cases were diagnosed as malignant and remaining 32 (64%) were diagnosed as benign. Among 18 malignant cases, maximum (n=11) were intraductal carcinoma (NOS), followed by well-differentiated intraductal carcinoma (n=6) and invasive lobular carcinoma (n=1) respectively. Among 32 benign cases, maximum (n=20) were fibroadenoma, followed by breast abscess (n=3), galactocele, intraductal papilloma and simple cyst (n=2 each). There was 1 case each diagnosed as fibroadenolipoma, fibrocystic and phyllode respectively. Diagnostic efficacy of USG in terms of sensitivity, specificity, positive and negative predictive value was 77.8%, 87.5%, 77.8% and 87.5% respectively. The accuracy of USG diagnosis was 84%. Diagnostic efficacy of USG elastography in terms of sensitivity, specificity, positive and negative predictive value was 83.3%, 96.9%, 93.8% and 91.2% respectively. The accuracy of elastography diagnosis was 92%. Diagnostic efficacy of MRI in terms of sensitivity, specificity, positive and negative predictive value was 94.4%, 90.6%, 85.0% and 96.7% respectively. The accuracy of MRI diagnosis was 92%. Conclusion: In low-resource settings, USG elastography can emerge as a suitable alternative to MRI in diagnosis of malignant breast masses with highly appreciable positive and negative predictive values. Study Design: Observational Study.

Benign Intraductal Papilloma Diagnosed on Imaging-Guided Breast Biopsy: Upgrade Rate to Carcinoma and to High-Risk Lesion

Objective: To determine the upgrade rates to carcinoma and to high-risk lesion (HRL) of benign intraductal papilloma (IDP) diagnosed on core needle biopsy (CNB) at Phramongkutklao (PMK) Hospital and to identify clinical or radiologic factors associated with the upgrading. Materials and Methods: Benign IDPs diagnosed on CNB between 2012 and 2020 were retrospectively reviewed. The ones with subsequent surgical excision or with more than two years of imaging follow-up to confirm benignity were included. The upgrade rates to carcinoma and to HRL were determined. Clinical and radiologic factors associated with the upgrade were analyzed. Results: Fifty-six benign IDPs diagnosed on CNB including 41 with subsequent excision and 15 with follow-up management were included. Of the 56 lesions, four (7.14%) were upgraded to carcinoma including three DCIS and one DCIS with grade 1 invasive carcinoma. Upgrade to HRL was found in two lesions (3.57%). No factor was found to be associated with the upgrading. Conclusion: At PMK Hospital, the upgrade rates of benign IDP diagnosed on CNB to carcinoma and to HRL were 7.14% and 3.57%, respectively. No factor was found to be associated with the upgrading. All upgraded cancers were of the early stage and low grade. Case-by-case management is recommended, based on these results together with patient’s risk, patient’s concern, and follow-up compliance. Keywords: Benign intraductal papilloma; Breast carcinoma; Breast biopsy; High risk lesion; Upgrade

Intraductal papillomas of the breast

: Papillary lesions of the breast are classified as benign or malignant. Making a definitive diagnosis for a papillary lesion based on a core needle biopsy remains a challenge for pathologists. Intraductal papillomas are a common benign lesion of the breast with variable presentations. They may be identified with or without atypia and may present with or without symptoms, often identified on breast imaging. Patients with intraductal papillomas with atypia should be referred for surgical excision due to the higher rate of upstaging to malignancy and they should also be referred for high risk assessment for possible chemoprevention. Unlike intraductal papillomas with atypia, there is no consensus for the management of intraductal papillomas without atypia and the management of intraductal papillomas without atypia has been controversial. Retrospective studies for intraductal papillomas without atypia have shown upstaging rates to carcinoma ranging from 0–33%. Excision can be considered for those patients presenting with symptoms such as palpable masses, nipple discharge or larger masses greater than 1 cm. Surgical excision is not indicated for asymptomatic intraductal papillomas without atypia where there is pathologic-radiographic concordance based on the prospective TBCRC 034 trial. The objective of this article is to review the current literature with series published over the last 5 years regarding intraductal papillomas with and without atypia and to summarize their management.

ASO Visual Abstract: Multidisciplinary Review of Intraductal Papilloma of the Breast Can Identify Patients Who May Omit Surgical Excision

ASO Visual Abstract: Multidisciplinary Review of Intraductal Papilloma of the Breast Can Identify Patients Who May Omit Surgical Excision

ASO Visual Abstract: Upgrade Rate and Predictive Factors for Breast Benign Intraductal Papilloma Diagnosed at Biopsy: A Meta-analysis

Current standard management for intraductal papilloma (IDP) diagnosed at biopsy indicates complete surgical resection, but there are increasing controversies over whether and when routine excision is indeed necessary. The purpose of this study ( https://doi.org/10.1245/s10434-021-10188-7 ) was to determine the carcinoma upgrade rate and identify the associated predictive factors for IDP diagnosed at biopsy by meta-analysis. We searched the PubMed and EMBASE database for studies published from 2009 to 2020 that investigated the upgrade rate and predictive factors of IDP diagnosed at biopsy. A total of 7016 IDP cases diagnosed at biopsy and histologically examined after surgical excision were pooled from 44 original studies. Patients with benign IDP exhibiting one or more predictive factors might benefit from surgical excision, whereas patients with asymptomatic benign IDP without these predictive factors can be managed by imaging surveillance.

Multidisciplinary Review of Intraductal Papilloma of the Breast can Identify Patients who may Omit Surgical Excision.

The purpose of this study was to define contemporary management recommendations regarding who would benefit from surgical excision of intraductal papilloma (IDP). A prospective database from a single institution identified patients with IDP on percutaneous biopsy from February 2015 to September 2020. Categorical patient demographic, biopsy, and pathologic variables were analyzed using Fisher's exact test and continuous demographic and imaging variables using the Mann-Whitney U test. IDP was present in 416 biopsies, at a median age of 56 years. The median size was 0.9cm, and the majority had greater than 50% of the target excised by biopsy. Surgical excision was performed for 124 of 416 biopsies (29.8%). Upgrade to malignancy was identified in 14 (11.3%): 8 to ductal carcinoma in situ (DCIS) and 6 to invasive cancer. Upgrade was significantly associated with concurrent ipsilateral breast cancer (p = 0.027), larger imaging size (p = 0.045), <50% excised with biopsy (p = 0.02), and atypia involving IDP (p = 0.045). Age, clinical presentation, and concurrent contralateral cancer were not significantly associated with upgrade. Lowest upgrade risk (0%) was in pure IDP ≤1 cm with >50% removed by biopsy. Of 401 biopsies that either did not upgrade or undergo excision, 7 (1.7%) developed subsequent breast cancer over a median follow-up of 23.5 months (interquartile range [IQR] 11,41), none at IDP site. After multidisciplinary review, the management of IDP can be stratified into low- and high-risk for upgrade groups using key criteria. Low-risk group may omit surgical excision, because those patients have 0% risk of upgrade over the limited short-term follow-up.

Upgrade Rate and Predictive Factors for Breast Benign Intraductal Papilloma Diagnosed at Biopsy: A Meta-Analysis.

Current standard management for intraductal papilloma (IDP) diagnosed at biopsy indicates complete surgical resection, but there are increasing controversies over whether and when routine excision is indeed necessary. The aim of this study was to determine the carcinoma upgrade rate and identify the associated predictive factors for IDP diagnosed at biopsy by meta-analysis. We searched the PubMed and EMBASE databases for studies published from 2009 to 2020 that investigated the upgrade rate and predictive factors of IDP diagnosed at biopsy. A total of 7016 IDP cases diagnosed at biopsy and histologically examined after surgical excision were pooled from 44 original studies. The pooled prevalence of IDP in breast biopsy findings was 4.6% [95% confidence interval (CI) 4.4-4.7%] and the majority of IDP tumors were benign. The pooled upgrade rates to carcinoma for benign IDP and atypical IDP were 5.0% (95% CI 4.4-5.5%) and 36.0% (95% CI 32.7-39.2%), respectively. In addition, we identified 10 predictive upgrade factors for benign IDP, including Breast Imaging Reporting and Data System (BI-RADS) 5, BI-RADS 4C, mass and calcification in the mammographic finding, bloody nipple discharge, imaging-histological discordance, peripheral IDP, palpable mass, BI-RADS 4B, microcalcification, and lesion size ≥ 1cm. The upgrade rates associated with these predictive factors ranged from 7.3 to 31.1%. Surgical excision appears a reasonable recommendation for atypical IDP. Patients with benign IDP exhibiting one or more predictive factors might benefit from surgical excision, while patients with asymptomatic benign IDP without these predictive factors can be managed by imaging surveillance.

Radiological evaluation of small-size solitary intraductal papilloma

Detection of intraductal papilloma can be difficult; however, conventional ductography, MRI, ultrasound, and ductoscopy play important roles in the diagnostic process. Intraductal papilloma is usually benign in nature, with a small parentage being malignant. When evaluating the average size of a papilloma, which is between 1 and 3 cm, both conventional ductography and MRI have high sensitivity in detection. However, MRI has slightly better sensitivity and less invasiveness in comparison with conventional ductography and is considered the state of art in evaluation of normal-size intraductal papilloma. A 40-year-old female patient presented with a history of clear nipple discharge from the left breast. Left breast had no palpable mass, and there were no skin changes. From the center part of the nipple, there was watery clear discharge (serous) from a single duct. No bloody nipple discharge was expressed from either nipple. Mammography was negative for masses or nipple retraction. Ultrasound demonstrated dilated duct with no intraductal mass. Conventional ductogram demonstrated dilated duct with abrupt cutoff and no filling defect. MRI did not demonstrate any mass except dilated duct. Owing to concavity seen in the ductogram, mammography-guided wire placement was done for the dilated duct and then surgically removed. Pathology revealed 2-mm intraductal papilloma, with no atypia or carcinoma in situ. Neither the conventional ductogram nor the MRI ductography proves to be a better method of diagnosing miniscule intraductal papilloma. Individually, both methods have the potential to emphasize various aspects of the ducts in a way that would be valuable to the reader.

Inverted Ductal Papilloma of the Salivary Gland

This is a case consult of slides stated to be from an excision of a buccal mucosa mass in a 58-year-old-man. The specimen was described as a 3 cm diameter roughly oval tan-gray tissue with a 2 x 1.5 cm mucosal ellipse on the surface that has a central ulcerated punctum. Cut section showed an underlying 1.7 cm diameter roughly oval well-circumscribed mass with a granular tan surface. Histological sections show a papillary lesion with an orifice on the mucosal surface and with epithelial nests invaginating into the underlying lamina propria in a non-infiltrative pattern. (Figure 1) The lesion is composed of papillary epithelial fronds with cleft-like spaces between the fronds. (Figure 2) The papillary fronds are lined by non-keratinizing basaloid stratified squamous cells with a superficial layer of columnar glandular cells along with mucous goblet cells interspersed among the squamous cells. (Figure 3) All the cellular components are devoid of cytologic atypia and mitoses. Based on these microscopic features we signed the case out as inverted ductal papilloma (IDP).&#x0D; &#x0D; Ductal papillomas are uncommon benign epithelial tumors with a papillary configuration that originate from the excretory ductal system of salivary gland acini.1-3 The World Health Organization recognizes two sub-types depending on the growth pattern: an intraductal papilloma (IP) and an IDP.1 An IDP usually presents as an asymptomatic submucosal nodule, measuring about 1.5 centimeters in diameter, and most commonly involving the buccal mucosa, followed by the lips, palate, and floor of the mouth.2,3 Histological sections typically show an unencapsulated though well-circumscribed epithelial proliferation with a papillary configuration on the luminal surface, and a nodular, endophytic or invaginating (“inverted”) configuration at its interface with the underlying lamina propria.2 Both the papillary and the invaginating areas are composed of basaloid, non-keratinizing stratified squamous epithelium that are often covered with a cuboidal or columnar ductal cell layer.2 Scattered among these are mucous goblet cells which can form microcysts.1,2 There is an overall morphological similarity to the sinonasal inverted papilloma.3 A relationship to trauma has been proposed.1,4 Association with Human Papilloma Virus (HPV) has also been reported.1 Others, however, have not been able to demonstrate this association.4&#x0D; &#x0D; Differential diagnoses primarily include IP - which is differentiated from IDP architecturally by being a unicystic intraluminal papillary proliferation within a dilated excretory duct 2 – and sialadenoma papilliferum – which is predominantly polypoid and pedunculated with a verrucoid surface rather than a submucosal nodule, and an over-all morphologic similarity to the cutaneous tumor syringocystadenoma papilliferum.1,4 An important differential diagnosis that has to be ruled out is mucoepidermoid carcinoma (MECA) because of the presence of both squamous and mucin-secreting cells. MECA is distinguished by poor circumscription, and an infiltrative solid-cystic growth pattern.2,4&#x0D; &#x0D; IDP is benign and non-recurrent. Unlike the nasal tumor, there has been no report of malignant transformation.2,3 Complete surgical excision is considered curative.1,2 Reporting these cases is encouraged to further our knowledge of the entity and elucidate a potential association with HPV.

Clinical practice guidelines for intraductal papilloma: Chinese Society of breast surgery (CSBrS) practice guidelines 2021.

Clinical practice guidelines for intraductal papilloma: Chinese Society of breast surgery (CSBrS) practice guidelines 2021.

Human Papillomavirus (HPV) Detection by Chromogenic In Situ Hybridization (CISH) and p16 Immunohistochemistry (IHC) in Breast Intraductal Papilloma and Breast Carcinoma

PurposeThis study explored human papillomavirus (HPV) amplification in breast benign and malignant lesions by chromogenic in situ hybridization (CISH) and the concordance of p16 expression by immunohistochemistry. Patients and MethodsThe presence of HPV6/11 and HPV16/18 in 33 cases of intraductal papilloma, 34 cases of ductal carcinoma in situ (DCIS), and 56 cases of invasive breast carcinoma (IBC) was evaluated using matched-background breast parenchyma and breast reduction as control groups. Association with clinicopathologic factors including prognosis was assessed. ResultsHPV 6/11 was observed in 0 cases (0%) of breast reduction, one case (3%) of intraductal papilloma, 11 cases (32.4%) of DCIS, and eight cases (14.3%) of IBC. HPV 16/18 was detected in three cases of (9.1%) breast reduction, six cases (18.8%) of intraductal papillomas, 14 cases (41.2%) of DCIS, and 25 cases (44.6%) of IBC. There was no difference in the HPV status between intraductal papilloma and breast reduction. HPV amplification in intraductal papilloma did not associate with developing atypia or carcinoma after long-term follow-up. However, HPV 6/11 and HPV 16/18 amplification was significantly higher in both DCIS and IBC when compared with breast reduction (P < .05). Compared with background breast parenchyma, HPV 16/18 amplification was significantly higher in both DCIS and IBC (P = .003 and P = .013, respectively). No correlation between p16 immunohistochemical staining and either of the HPV CISH testing was found (P > .05). ConclusionHPV infection was detected in both breast lesions and background parenchyma. HPV infection may play a role in the pathogenesis of breast cancer but is not associated with intraductal papilloma. Immunohistochemical stain for p16 is not a good surrogate marker for HPV infection in breast lesions.

Intraductal Papilloma of the Breast: Prevalence of Malignancy and Natural History Under Active Surveillance.

The optimal management of intraductal papillomas (IPs) without atypia diagnosed on needle core biopsy (NCB) is unclear. This study analyzed the malignancy risk of immediately excised IPs and characterized the behavior of IPs under active surveillance (AS). We retrospectively reviewed the pathology and imaging records of patients diagnosed with IPs without atypia on NCB during a 10-year period (1999-2019). The malignancy upgrade rate was assessed in patients who had an immediate surgical excision, and the rates of both radiographic progression and development of malignancy were assessed in a cohort of patients undergoing AS. The inclusion criteria were metin 152 patients with 175 IPs with a mean age of 51 ± 13 years. The average size of the IPs on initial imaging was 8 ± 4 mm. Most of the lesions (57%, n = 99) were immediately excised, whereas 76 (43%) underwent AS with interval imaging witha median follow-up period of 15months (range, 5-111months). Among the immediately excised IPs, surgical pathology revealedbenign findings in 97% (n = 96) and ductal carcinoma in situ in 3% (n = 3). In the AS cohort, 72% (n = 55) of the IPs remained stable, and 25% (n = 19) resolved or decreased in size. At 2 years, 4% had increased in size on imaging and were subsequently excised, with ductal carcinoma in situ (DCIS,n = 1) and benign pathology (n = 1) noted on final pathology. In a large series of breast IPs without atypia, no invasive carcinoma was observed after immediate excision, and 96% of the lesions had not progressed on AS. This suggests that patients with IP shown on NCB can safely undergo AS, with surgery reserved for radiographic lesion progression.

Genome-wide DNA methylome and whole-transcriptome landscapes of spontaneous intraductal papilloma in tree shrews.

BackgroundBreast intraductal papilloma (IP) is mainly caused by the abnormal proliferation of ductal epithelial cells. Tree shrews have potential as an animal model for the study of breast tumours; however, little is known regarding the transcriptome and DNA methylome landscapes of breast IP in tree shrews. In this research, we conducted whole-genome DNA methylation and transcriptome analyses of breast IP and normal mammary glands in tree shrews.MethodsDNA methylation profiles were generated from the whole-genome bisulfite sequencing and whole-transcriptome landscapes of IP and control groups of tree shrews through strand-specific library construction and RNA sequencing. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes functional enrichment analyses and gene set enrichment analysis were performed. Spearman’s correlation analysis was used to identify statistical relationships between gene expression and DNA methylation.ResultsA genome-wide perspective of the epigenetic regulation of protein-coding genes in breast IP in tree shrews was obtained. The methylation levels at CG sites were considerably higher than those at CHG or CHH sites, and were highest in gene body regions. In total, 3,486, 82 and 361 differentially methylated regions (DMRs) were identified in the context of CG, CHG, and CHH, respectively, and 701 differentially methylated genes (DMGs) were found. Further, through transcriptomic analysis, 62 differentially expressed genes, 50 long noncoding RNAs, and 32 circular RNAs were identified in breast IP compared to normal mammary glands. Correlation analysis between the DNA methylation and transcriptome data revealed that 25 DMGs were also differentially expressed genes, among which the expression levels of 9 genes were negatively correlated with methylation levels in gene body regions. Importantly, integrated analysis identified 3 genes (PDZ domain-containing 1, ATPase plasma membrane Ca2+ transporting 4 and Lymphocyte cytosolic protein 1) that could serve as candidates for further study of breast IP in tree shrews.ConclusionsThis research has unearthed the comprehensive landscape of the transcriptome and DNA methylome of spontaneous IP in tree shrews, as well as candidate tumorigenesis related genes in IP. These results will contribute to the use of tree shrews in animal models of breast tumours.

Cytological Evaluation of Pathological Male Breast Lesions.

This study aimed to determine the cytodiagnostic spectrum of various male breast lesions, which were corroborated on histopathology as appropriate, to describe the process of the cytomorphology of some uncommon pathological lesions, and to discuss the reasons of their misdiagnoses. In this 8-year study, a total of 114 patients underwent fine needle aspiration cytology (FNAC). In a representative case, nipple discharge from an 8-month-old child was examined. Confirmatory histopathology was obtained in 38 cases only. Gynecomastia was the most common (63.5%) male breast pathology. Invasive breast carcinoma of no special type was the most common variant of male breast malignancy. Half of the "gray zone" of cytological lesions was confirmed as cancer, but the rest were diagnosed as fibrocystic disease and intraductal papilloma. All cases with malignant cytology matched their corresponding histopathology. However, a tumor from an intraductal papillary carcinoma was miscued as ductal carcinoma on previous FNAC. Cytological evaluation of male breast lesions provides highly sensitive and specific results with excellent histologic reproducibility. Thus, it should be the ideal pretherapeutic diagnostic procedure for male breasts. However, some benign pathological conditions, which are particularly associated with epithelial hyperplasia, perplex the cytomorphologic scenario into the "gray zone."

English

BACKGROUND The breast tissue consists of both specialised epithelial cells and stroma. It is a site of a broad array of pathological alterations. Both benign and malignant lesions can occur in the breast. Breast cancer is the most commonly diagnosed female cancer accounting for 20 % of female malignancies globally. METHODS The study was carried out to evaluate the histopathological patterns of 589 breast lesions whose biopsied breast tissues were presented at the Pathology department of Tezpur Medical College and Hospital, Tezpur, Assam, for a period of three (03) years from January 01, 2017 to December 31, 2019. RESULTS Out of 589 cases of breast lesions, 418 were benign breast lesions (70.97 %) and 171 were malignant (29.03 %) with a benign and malignant ratio of 2.44:1. Fibroadenoma breast was the most common benign breast disease were 264 out of 418 (63.15 %) and infiltrating duct carcinoma was the commonest malignant breast lesions, in this study there were 123 out of 171 (71.93 %). Among 123 cases of infiltrating duct carcinoma, 93 (75.61 %) were grade III ;27 (21.95 %) were grade II and 03 (2.44 %) were grade I as per Nottingham histologic score system in the study group. Metastatic lymph nodes were 89 (52.05 %) were seen in the malignant cases. Early presentation (stage 0, I and II) constituted 77 (45.45 %) while late presentation (stage III and VI) accounted for 94 (54.97 %) in the breast malignancy in the study. CONCLUSIONS Histopathological study plays very important role in the diagnosis, treatment and prognosis of breast lesions. This study highlighted the distinct incidences and pathological characteristics of wide range of breast diseases and affirmed that breast cancers in developing countries like India are characterised by late presentation. KEYWORDS Fibroadenoma, Duct Papilloma, Lipoma, Infiltrating Duct Carcinoma, Ductal Ca in Situ, Invasive Lobular Carcinoma, Lobular Carcinoma in situ, Medullary Carcinoma, Mucinous Carcinoma, Malignant Phyllodes

Diagnostic value of sialyl-Tn immunocytochemistry in breast cancer presenting with pathological nipple discharge.

BackgroundMucin‐associated sialyl‐Tn (sTn) antigen is overexpressed and related with adverse outcome in breast cancer (BC). The role of sTn in BC has not been well defined in pathological nipple discharge (PND) cytology. The authors examined sTn immunocytochemistry (ICC) in PND to determine whether it could be a biomarker of malignancy or aggressive disease.MethodsPND was subjected to immunocytochemical staining for sTn antigen expression and thinprep cytology test (TCT) for enhancing the sensitivity and specificity. The examination data was compared with histological findings of subsequent biopsy specimens. Logistic regression analysis was used to determine which factors were most associated with malignant breast lesions.ResultsPND specimens were collected including 120 cases of intraductal papilloma, 24 cases of hyperplasia, 45 cases of ductal carcinoma in situ (DCIS), and 48 cases of invasive ductal carcinoma (IDC). STn ICC differentiated BC from benign intraductal lesions with a low sensitivity of 41.9% and a high specificity of 95.8%, but increased in combination with TCT to 64.5% and 100%, respectively. A high degree of concordance was observed between the results of sTn expression in cell smears and histological specimens. Moreover, the sTn expression was strongly associated with HER2‐positive IDC (p = 0.039). Multivariate logistic analysis showed that positive sTn expression (OR: 14.241, 95%CI: 2.574, 78.794, p = 0.010) and accompanying mass (OR: 3.307, 95%CI: 1.073, 10.188, p = 0.037) were statistically significant independent risk factors for malignant PND.ConclusionsMucin‐associated sTn expression in PND cytology appears to be a reliable diagnostic marker for BC patients with the chief complaint of malignant nipple discharge and indicates a more aggressive behavior in IDC.

English

BACKGROUND The breast is composed of both specialised epithelial cells and stroma. Both benign and malignant lesions can occur in the breast as a palpable lump. Fine needle aspiration cytology (FNAC) is a rapid, easy to perform, minimally invasive and low cost first line high-diagnostic accuracy test for cytopathological evaluation of palpable breast lump with minimum complications. METHODS The study was carried out to evaluate the cytopathological patterns of 2706 palpable breast lumps by fine needle aspiration (FNA) procedure and cytohistopathological correlation of the available biopsied palpable breast lumps of the study in the Pathology department of Tezpur Medical College and Hospital, Assam, for a period of three years from July 01, 2016 to June 30, 2019. RESULTS Out of 2706 palpable breast lumps in the study, FNA smears of 19 (0.70 %) were inadequate for cytopathological reporting. Out of the remaining 2687 palpable breast lumps where FNA was adequate for cytopathological reporting, female patients (n = 2594) comprised 96.54 % and male patients (n = 93) comprised 3.46 % with a male and female ratio of 1:27.9. Out of the 2687 palpable breast lumps, 2318 were benign breast diseases (86.27 %) and 369 were malignant neoplasms (13.73 %), with a benign and malignant ratio of 6.28:1. Out of the benign breast lumps, fibroadenoma breast was seen in 1228 (52.98 %) and of the malignant neoplasms, infiltrating duct carcinoma was seen in 341 (92.41 %). Cytohistopathological correlation showed 98.70 % sensitivity, 99.38 % specificity, 99.35 % positive predictive value, 98.76 % negative predictive value, and 99.04 % diagnostic accuracy. CONCLUSIONS FNAC has high sensitivity and specificity in cytopathological diagnosis of palpable breast lumps. Based on the accurate cytopathological diagnosis of the palpable breast lumps, patients with palpable breast lumps can be given adequate treatment. KEYWORDS Fibroadenoma, Gynaecomastia, Duct Papilloma, Infiltrative Duct Carcinoma, Medullary Carcinoma, Mucinous Carcinoma, Malignant Phyllodes

Accuracy of mammography and sonomammography and its correlation with histopathology in the detection of breast cancer

Background: Mammography (MMG) plays a pivotal role in the early diagnosis of breast cancer (BC). However, it is sometimes difficult to use it to diagnose palpable breast lesions among young patients. Ultrasound can be used as an adjunct in differentiating cystic and solid masses. Studies evaluating the combination of MMG and sonomammography (SMG) as an adjunct to detect Breast cancer, are quite scarce in the literature. This study aimed to assess the accuracy of MMG and to comprehend the role of ultrasound as an adjunct to MMG for finding breast lesions.Methods: Women attending the outpatient department (OPD) with complaints of breast lump, or those undergoing MMG screening were included. All patients then subsequently underwent MMG, SMG and biopsy. MMG and SMG findings were then correlated with the histopathology results.Results: Irregular shape and calcifications (MMG) and hypoechoic pattern (SMG) were found to be significant features differentiating malignant from benign lesions. Calcifications in benign tumors were observed 5.05 times less frequently than in malignant tumors. MMG combined with SMG had a sensitivity of 90.4%, specificity of 82.4%, positive and negative predictive value of 95% and 67% respectively, along with an accuracy of 88.9% in differentiating benign from malignant masses.Conclusions: SMG used as an adjunct to MMG is a reliable modality, especially in detecting lesions that are not picked up on MMG, including intraductal papilloma and duct ectasia.

Papillary neoplasms of the breast-reviewing the spectrum.

Papillary neoplasms of the breast encompass a wide range of tumor types ranging from the benign intraductal papilloma to in situ and invasive papillary carcinomas. In this review, we considered each tumor entity listed under the Papillary Neoplasms category in the latest WHO Classification of Breast Tumors (5th edition), namely intraductal papilloma, papillary ductal carcinoma in situ, encapsulated papillary carcinoma, solid-papillary carcinoma, and invasive papillary carcinoma. We examined their pathological features, current issues pertaining to diagnosis and prognostication, as well as the latest molecular findings. We also briefly addressed adenomyoepithelioma and the newly included tall cell carcinoma with reversed polarity, highlighting areas where they overlap with papillary neoplasms.