Epithelial Atypia Research Articles

High risk breast lesions identified on MRI-guided vacuum-assistedneedlebiopsy: outcome of surgical excision and imaging follow-up.

To determine whether breast MRI-guided vacuum-assisted biopsy (MRI-VAB) high-risk lesion histology influences surgical or long-term imaging follow-up outcomes. Patients with imaging-concordant high-risk findings on 9-gauge breast MRI-VAB between January 2007 and July 2012 who had surgical histopathology or 2 year imaging follow-up were retrospectively reviewed. 90 patients with 99 lesions were included. Lesions were atypical ductal hyperplasia (ADH) (n=21), lobular neoplasia [n = 36; atypicallobular hyperplasia (ALH) (n = 22), lobularcarcinoma in situ (LCIS) (n = 6), and ALH plus LCIS (n = 8)], and other high-risk lesion (n = 42; papillary lesions, radial scar, flat epithelial atypia, atypia unspecified). Of 53 excised lesions, 6 (11%) were upgraded to invasive cancer or ductal carcinoma in situ (DCIS). 4 of 21 (19%) ADH lesions were upgraded to DCIS. 2 of 36 (6%) lobular neoplasia lesions, both combined ALH and LCIS, were upgraded to DCIS, and invasive lobular carcinoma, respectively. The remaining 46 lesions were managed conservatively with imaging follow-up: 17 (37%) had mammography only, while 29 (63%) had mammography and MRI follow-up. There was no evidence of breast cancer development at the site of MRI-VAB in the cases with only imaging follow-up. We conclude that the upgrade rate for high-risk lesions at MRI-VAB at surgical excision is low. Surgical excision is warranted for ADH and combined ALH-LCIS lesions. For other lesions, a multidisciplinary approach to decide on personalized management may be appropriate. Surgical excision is warranted for ADH lesions and combined ALH-LCIS lesions identified at breast MRI-VAB. A multidisciplinary approach to patient management of other high-risk lesions may be appropriate.

Flat epithelial atypia in directional vacuum-assisted biopsy of breast microcalcifications: surgical excision may not be necessary

AbstractThe aim of this study was to analyze the clinicopathological features of patients with flat epithelial atypia, diagnosed in directional vacuum-assisted biopsy targeting microcalcifications, to identify upgrade rate to in situ ductal or invasive breast carcinoma, and determine factors predicting carcinoma in the subsequent excision. We retrospectively evaluated the histological, clinical, and mammographic features of 69 cases from 65 women, with directional vacuum-assisted biopsy-diagnosed flat epithelial atypia with or without atypical ductal hyperplasia or atypical lobular hyperplasia, which underwent subsequent surgical excision. The extent and percentage of microcalcifications sampled by directional vacuum-assisted biopsy were evaluated by mammography. All biopsy and surgical excision slides were reviewed. The age of the women ranged from 40 to 85 years (mean 57 years). All patients presented with mammographically detected microcalcifications only, except in one case that had associated architectural distortion. Extent of calcifications ranged from <1 cm (n = 47), 1–3 cm (n = 15) to > 3 cm (n = 6), and no measurement (n = 1). A mean of 11 cores (range 6–25) was obtained from each lesion. Post-biopsy mammogram revealed >90% removal of calcifications in 81% of cases. Pure flat epithelial atypia represented nearly two-thirds of directional vacuum-assisted biopsy specimens (n = 43, 62%), while flat epithelial atypia coexisted with atypical ductal hyperplasia (18 cases, 26%), or atypical lobular hyperplasia (8 cases, 12%). Upon excision, none of the cases were upgraded to in situ ductal or invasive breast cancer. In one case, however, an incidental, tubular carcinoma (4 mm) was found away from biopsy site. Excluding this case, the upgrade rate was 0%. Our study adds to the growing evidence that diagnosis of flat epithelial atypia on directional vacuum-assisted biopsy for microcalcifications as the only imaging finding is not associated with a significant upgrade to carcinoma on excision, and therefore, excision may not be necessary. Additionally, excision may not be necessary for flat epithelial atypia with atypical ductal hyperplasia limited to ≤2 terminal duct-lobular units, if at least 90% of calcifications have been removed on biopsy.

Variability in the Management Recommendations Given for High-risk Breast Lesions Detected on Image-guided Core Needle Biopsy at U.S. Academic Institutions

The purpose of this study was to describe and compare the management recommendations provided in the setting of a high-risk lesion diagnosed on core needle biopsy of the breast at academic institutions across the United States. We contacted breast imagers at U.S. academic institutions via email and asked them to complete a voluntary online survey. The survey consisted of eight questions regarding the management recommendations given when core biopsy yields various high-risk lesions. We received survey responses from 41 of the 59 institutions contacted (69% response rate). Surgical excision was the most frequently reported recommendation given for all high-risk lesions; however, the proportion varied from 95% for atypical ductal hyperplasia and papilloma with associated atypia, 76% for flat epithelial atypia, 73% for radial scar/complex sclerosing lesion, 71% for lobular carcinoma in-situ, 61% for atypical lobular hyperplasia, to 39% for intraductal papilloma without atypia. Our study demonstrates inconsistency in the management recommendations given for high-risk lesions detected on core needle biopsy at academic institutions nationally. This outcome suggests that patients may benefit from the creation of consensus recommendations for the management of high-risk lesions detected on core needle biopsy.

Relevance of B3 lesions in breast diagnosis – frequency and therapeutic consequences

AbstractWith improvements in breast imaging and minimally invasive interventions, detection of early breast cancer has increased. However, with the improved diagnostic capabilities, the risk of false-positive benign lesions as well as lesions classified as B3 by histopathology has also increased. Varying rates of malignancies are associated with B3 lesions, raising the question of whether such lesions should always be surgically removed. The results of our retrospective analysis should assist in this decision-making process.307 core needle or vacuum-assisted needle biopsies in which B3 lesions were found were examined. The most common lesions were intraductal papillomas (44 %), atypical ductal hyperplasia (22.8 %), flat epithelial atypia (9.4 %), phyllodes tumours (6.5 %), radial scars (5.9 %), LIN 1 (4.9 %), complex fibroadenomas (3.3 %) and LIN 2 (1.6 %). The frequencies depended considerably on whether the tissue was obtained by core biopsy or vacuum biopsy. Stereotactic vacuum biopsy was generally performed in the case of microcalcification not apparent on sonography. Lesions visible on ultrasound had core needle biopsy.Surgery was performed in 254 cases and a malignancy was found in 27.2 % on the final histopathology. Malignancy was found in 24.6 % of 114 cases initially diagnosed as intraductal papilloma. Similarly, cancer was discovered in 48.4 % of the 62 cases of atypical ductal hyperplasia, in 2.4 % of the 41 cases of flat epithelial atypia, complex fibroadenoma and phyllodes tumour, in 20.7 % of the 29 cases of LIN 1 and radial scar as well as in 50 % of the 8 cases of LIN 2, adenomyoepithelioma and atypical apocrine metaplasia.These data indicate the necessity for complete surgical removal of a B3 lesion when it is discovered using the core needle or vacuum-assisted biopsy technique. The decision not to perform surgery can be made when the risk of associated malignancy is deemed low in the clinical pathology conference, but careful follow-up is essential.

Sa1239 CAN WE PREDICT THE RISK OF ADENOCARCINOMA FOR GASTRIC ATYPICAL EPITHELIUM ON ENDOSCOPIC BIOPSY?

The treatment guidelines for Gastric atypical epithelium (GAE), classified as “indefinite for dysplasia” in the revised Vienna classification, are not well established because their malignancy potential and prognosis are unclear. The aim of this study was to analyze the rate, risk factors and diagnostic delay of GAE diagnosed as adenocarcinoma. The Clinicopathologic factors of 461 stomach lesions, diagnosed as GAE by initial endoscopic biopsy between January 2006 and December 2015, were reviewed. Final pathologic diagnoses were made by endoscopic resection (n=134, 29.0%), operation (n=22, 4.7%) and follow-up endoscopic biopsy (n=305, 66.1%). Adenocarcinomas were finally diagnosed in 104 cases (22.5%). In Multivariate analysis, Age≥60 [odd ratio (OR) 2.25, 95% confidence interval (CI) 1.23-4.13], endoscopic lesion size ≥ 10 mm (OR 2.68, 95% CI 1.45-4.93), single lesion (OR 6.06 95% CI 2.39-15.96), spontaneous bleeding (OR 2.54, 95% CI 1.12-5.77), abnormal glandular structure in histology (OR 23.59, 95% CI 9.95-55.91) and repeated GAE in the next endoscopy procedure (OR 7.35, 95% CI 2.06-26.15) were independent risk factors for adenocarcinoma (Table 1). The mean interval from the initial biopsy to the final diagnosis of adenocarcinoma was 116.70 ± 324.46 (median = 27) days. Diagnostic delay was defined according to the time interval in which the 76th to 100th percentiles of cases were diagnosed [406.42±538.08 (median =153) days]. However, the diagnostic delay was not associated with submucosal invasion, pathologic size, cancer differentiation, lymphovascular invasion, complete resection, additional surgery after endoscopic resection, and recurrence (Table 2). GAE with risk factors (Age≥60, endoscopic lesion size ≥ 10 mm, single lesion, spontaneous bleeding, abnormal glandular structure in histology, and repeated GAE in the next endoscopy procedure) should consider the possibility of adenocarcinoma. Without risk factors, the evidence that the delay of diagnosis affects prognosis is unclear, accurate diagnosis through follow-up endoscopic biopsy will be helpful.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Should we excise? Are there any clinical or histologic features that predict upgrade in papillomas, incidental or non-incidental?

The clinical decision to excise intraductal papilloma (IDP) without atypia diagnosed on biopsy remains controversial. We sought to establish clinical and histologic predictors (if any) which may predict upgrade in IDP. 296 biopsies (in 278 women) with histologic diagnosis of IDP without atypia were retrospectively identified and placed into Incidental (no corresponding imaging correlate), or Non-incidental (positive imaging correlate) groups. 253/296 (85.5%) cases were non-incidental, and 43/296 (14.5%) were incidental. 73.1% (185/253) non-incidental and 48.8% (21/43) incidental cases underwent excision. 12.4% (23/185) non-incidental cases underwent an upgrade to cancer or high-risk lesion; namely 8-Ductal carcinoma in situ (DCIS), 8-atypical ductal hyperplasia (ADH), 6-lobular neoplasia, and 1-flat epithelial atypia. There was no histopathologic feature on the biopsy in the non-incidental group which predicted upgrade; however a past history of atypia was significantly associated with upgrade. 2 of the 21 incidental cases upgraded (1 to ADH and 1 to lobular neoplasia); the former had a past history of ADH. Both incidental upgrades were >1 mm in size, and were not completely excised on the biopsy. None of the incidental cases which appeared completely excised on biopsy upgraded, irrespective of the size on biopsy. These findings suggest that all non-incidental IDPs should be considered candidates for surgical excision, given the 12.4% upgrade rate and no definitive histologic predictors of upgrade. Patients with incidental IDPs (if <1 mm, completely excised on biopsy and with no history of high risk breast lesion) can be spared excision.

Deep Learning or Fundamental Descriptors?

HomeRadiologyVol. 287, No. 2 PreviousNext CommunicationsFree AccessLetters to the EditorDeep Learning or Fundamental Descriptors?Daniel B. Kopans Daniel B. Kopans Author AffiliationsDepartment of Radiology, Breast Imaging Division, Massachusetts General Hospital, Harvard Medical School, 15 Parkman St, Suite 219, Boston, MA 02114e-mail: [email protected]Daniel B. Kopans Published Online:Apr 18 2018https://doi.org/10.1148/radiol.2017173053MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail Editor:Having placed great hope on computer-aided detection (CAD) back in the 1990s only to be disappointed in its ultimate failure to add much in breast imaging, I am still hopeful, but have a healthy skepticism, about “deep learning,” which is simply CAD on steroids. The article by Dr Bahl and colleagues (1) in the March 2018 issue of Radiology is interesting, but by mixing too many “high-risk lesions” (HRLs) together in the evaluation, as well as not analyzing the reasons for the computer results, the real value of the analysis is in question. As Dr Bahl and colleagues point out, the categories of lesions lumped (sorry) together reduces the ability to understand the value of the test. The HRLs included are widely differing in their etiology and histology as well as their risk for developing breast cancer and “upgrade” with excision. For example, the risk of upgrade for atypical ductal hyperplasia is much higher than that for flat epithelial atypia or a benign papilloma. This is clear in a recent article by two of the same authors (probably including many of the same patient lesions) showing that the upgrade rate for flat epithelial atypia by itself was extremely low at less than 3% (2). I suspect that they grouped the various HRLs together so that they had enough cases to be able to “train” the computer algorithms and then test them.What is not provided is the fact that if a trained radiologist reviewed the same cases and was asked to guess the rate of upgrade for each lesion, she or he would have likely done as well as the computer for many of the lesions. For example, if you performed a core biopsy of segmentally distributed pleomorphic calcifications and the pathologic examination revealed “atypical ductal hyperplasia” you would be fairly certain that the upgrade would reveal at least ductal carcinoma in situ. If, on the other hand, you biopsied and removed five or six borderline round calcifications that produced “atypical ductal hyperplasia,” you would likely be correct if you bet that the surgical excision would not lead to an upgrade.It is worth investigating the use of more powerful computers, but we need to remain skeptical until the data show a clear advantage. I would urge that investigators not simply report results, but be required to analyze histopathologically distinct lesions, separately, and not group lesions together as in this analysis. I would also urge that they try to understand what the computer was adding to a trained radiologist. It may be that simply by reading “pleomorphic” and “segmental” a computer algorithm will call for excision, and “deep learning” is not as deep as we would hope!Disclosures of Conflicts of Interest: disclosed no relevant relationships.

Fine needle aspiration cytology finding of a parotid mass with chondromyxoid matrix and variable epithelial cytological atypia.

Fine needle aspiration cytology finding of a parotid mass with chondromyxoid matrix and variable epithelial cytological atypia.

How Do We Approach Benign Proliferative Lesions?

The aim of this review is to summarize recently published literature addressing atypical ductal hyperplasia (ADH), lobular neoplasia (atypical lobular hyperplasia [ALH] and classic lobular carcinoma in situ [C-LCIS]), non-classic lobular carcinoma in situ (NC-LCIS), papillary lesions, and flat epithelial atypia (FEA). While ADH, ALN, and C-LCIS are well-established markers of an increased risk of future breast cancers, the risk implications are less clear for papillary lesions and FEA. NC-LCIS is the least well-characterized lesion, with scant published literature on its natural history and surgical management when encountered on needle biopsy. Recent data suggest that lobular neoplasia on core biopsy of a BI-RADS ≤ 4 concordant lesion does not require an excision, while ADH, atypical papillomas, and NC-LCIS should be excised. Evidence on FEA and papillomas without atypia suggests a low risk of upgrade on excision, and prospective studies on the upgrade of these lesions are ongoing.

Abstract ES2-2: Clinical management of women with increased breast cancer risk based on histologic lesions

Abstract The objective of this lecture is to review clinical management of women with the following histologic lesions associated with increased breast cancer risk: flat epithelial atypia (FEA), atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and lobular carcinoma in situ (LCIS). Women found to have one or more of these histologic findings in a benign breast biopsy have an increased risk of developing a future breast cancer. Published data will be reviewed that provides estimates of annual and longterm risk associated with these lesions. In addition, management of these lesions after core biopsy will be discussed, specifically the circumstances when surgical excision is recommended. Medical and surgical options for breast cancer risk reduction will be reviewed, as well as their appropriate clinical indications. Citation Format: Degnim AC. Clinical management of women with increased breast cancer risk based on histologic lesions [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr ES2-2.

Pathologic Upgrade Rates of High-Risk Breast Lesions on Digital Two-Dimensional vs Tomosynthesis Mammography

Our aim was to compare the pathologic upgrade rates of high-risk breast lesions (HRLs) on digital two-dimensional mammography (DM) vs digital breast tomosynthesis (DBT). The study cohort was composed of patients with HRLs diagnosed by image-guided core needle biopsy from December 2007 to February 2011 (DM group, before DBT integration) and from January 2013 to March 2016 (DBT group, after complete DBT integration). Medical records were reviewed for surgical outcomes and follow-up imaging. Eight hundred and ninety-three patients with 900 biopsy-proven HRLs underwent surgical excision (97.0% [873 of 900]) or had at least 2 years of imaging follow-up (3.0% [27 of 900]). The most common HRL was atypical ductal hyperplasia in the DM and DBT groups (37.4% [337 of 900]). The overall upgrade rate of HRLs to malignancy was 11.3% (102 of 900). There were no statistically significant differences in overall upgrades rates of HRLs on DM vs DBT (11.4% [54 of 475] vs 11.3% [48 of 425]; p= 0.97) or in upgrade rates of HRL subtypes. However, HRLs that upgraded on DBT were more likely to be invasive rather than in situ carcinoma compared with HRLs that upgraded on DM (39.6% [19 of 48] vs 20.4% [11 of 54]; p= 0.03). Overall, the most common HRL to upgrade was atypical ductal hyperplasia (18.4% [62 of 337]). The least common HRLs to upgrade in the DBT group were biphasic neoplasms (0% [0 of 22]), flat epithelial atypia (1.6% [1 of 62]), and papillomas without atypia (4.5% [2of44]). There is no difference in the upgrade rates of HRLs on DM vs DBT, but the proportion of HRL upgrades that are invasive rather than in situ carcinoma is higher with DBT.

Approach to the diagnosis of dysplasia in the gallbladder

Gallbladder is one of the more commonly removed organs with 1 million cholecystectomies performed annually in the US. Epithelial atypia with the differential diagnosis of reactive vs dysplasia vs carcinoma is not uncommon and is notoriously challenging. Recently, improved criteria were established for this differential through international consensus meetings, and sampling protocols have been put forth. In high GBC-risk regions, or high-risk patients like hyalinising/porcelain GB or PSC or pancreatobiliary maljunction, any atypia warrants careful attention and extensive sampling. In low risk situations, if atypia with suspicion of low-grade dysplasia (LGD) is encountered, 4 additional blocks are recommended, and in the absence of convincing HGD, no additional action is required; LGD by itself is regarded clinically inconsequential except for heralding HGD. HGD is often extensive by the time of diagnosis, involving most of the preserved mucosa (‘wild-fire phenomenon’) and shows severe atypia that is typically recognisable even in low power examination. HGD [aka CIS, or early gallbladder cancer (EGBC) due to the difficulty in distinguishing Tis from T1a/b] is curable disease provided that T2 (perimuscular) invasive carcinoma is carefully ruled out by total sampling. It is recommended that a case not be classified as HGD/CIS/EGBC if the GB has not been examined in toto.

Current Management of High-Risk Breast Lesions

The purpose of this review is to describe recent updates in the management of high-risk breast lesions. We review the various high-risk breast lesions and evaluate the collective literature regarding the rates of upgrade to invasive cancer or ductal carcinoma in situ with excisional biopsy as well as the increased risk for future breast cancer development that a diagnosis of a high-risk breast lesion may portend. For those lesions associated with an increased risk of breast cancer, we discuss the appropriate surveillance regimens as well as risk reduction opportunities available to patients. Recent studies may suggest a role for close imaging observation in certain clinical settings when a benign intraductal papilloma or flat epithelial atypia is identified by core needle breast biopsy. Ongoing prospective clinical trials should reveal valuable data to help answer this question. Clinical management of high-risk breast lesions identified and determined to be concordant after image-guided core needle biopsy varies and prospective data are needed to better guide management decisions. High-risk breast lesions require close radiologic-pathologic correlation when diagnosed by image-guided breast core needle biopsy. Excisional biopsy can exclude a higher-grade lesion such as DCIS or invasive cancer; however, in certain cases, close observation with follow-up may be appropriate. Additionally, women who have certain high-risk lesions such as lobular carcinoma in situ, atypical ductal hyperplasia, or atypical lobular hyperplasia are at an increased risk for the future development of breast cancer and should undergo risk assessment and discussion of risk reduction measures. Ongoing and future prospective trials may provide data to better guide these management decisions and optimize patient care.

Gamma Imaging-Guided Minimally Invasive Breast Biopsy: Initial Clinical Experience.

The purpose of this study was to evaluate our initial experience with gamma imaging-guided vacuum-assisted breast biopsy in women with abnormal findings. A retrospective review of patients undergoing breast-specific gamma imaging (BSGI), also known as molecular breast imaging (MBI), between April 2011 and October 2015 found 117 nonpalpable mammographically and sonographically occult lesions for which gamma imaging-guided biopsies were recommended. Biopsy was performed with a 9-gauge vacuum-assisted device with subsequent placement of a titanium biopsy site marker. Medical records and pathologic findings were evaluated. Of the 117 biopsies recommended, 104 were successful and 13 were canceled. Of the 104 performed biopsies, 32 (30.8%) had abnormal pathologic findings. Of those 32 biopsies, nine (28.1%) found invasive cancers, six (18.8%) found ductal carcinoma in situ (DCIS), and 17 (53.1%) found high-risk lesions. Of the 17 high-risk lesions, there were three (17.6%) lobular carcinomas in situ, five (29.4%) atypical ductal hyperplasias, two (11.8%) atypical lobular hyperplasias, one (5.9%) flat epithelial atypia, and six (35.3%) papillomas. Two cases of atypical ductal hyperplasia were upgraded to DCIS at surgery. The overall cancer detection rate for gamma imaging-guided biopsy was 16.3%. In this study, gamma imaging-guided biopsy had a positive predictive value of total successful biopsies of 16.3% for cancer and 30.8% for cancer and high-risk lesions. Gamma imaging-guided biopsy is a viable approach to sampling BSGI-MBI-detected lesions without sonographic or mammographic correlate. Our results compare favorably to those reported for MRI-guided biopsy.

Peritoneal carcinomatosis after risk-reducing surgery in BRCA1/2 mutation carriers.

Risk-reducing salpingo-oophorectomy (RRSO) is recommended for BRCA1/2 mutation carriers because of their increased risk of ovarian carcinoma. Despite RRSO, metachronous peritoneal carcinomatosis occasionally is diagnosed. The literature was searched for BRCA1/2 mutation carriers with peritoneal carcinomatosis after risk-reducing surgery. The authors were asked for additional data. Clinical and histopathological data were descriptively analyzed. Cases were compared with a single-institution control cohort. Of 36 cases, 86.1% concerned BRCA1 mutation carriers. The median age of the patients was 52 years (range, 30-71 years) at the time of risk-reducing surgery and 60 years (range, 37-75 years) at the time of diagnosis of peritoneal carcinomatosis. The median interval between the 2 events was 54.5 months (range, 11-292 months). Peritoneal carcinomatosis was mostly high-grade serous carcinoma. Histopathological details of the RRSO specimens were retrieved in 8 cases; 5 (62.5%) were found to have serous tubal intraepithelial carcinoma and 1 had epithelial atypia. Cases were older (P = .025) at the time of risk-reducing surgery and harbored more serous tubal intraepithelial carcinomas (P<.001) compared with women from the control cohort. Metachronous peritoneal carcinomatosis after risk-reducing surgery occurs predominantly in BRCA1 mutation carriers, usually within 5 years. Data have suggested that surgery at a younger age lowers the rates of peritoneal carcinomatosis. These data can be used in the gynecologic counseling of BRCA1/2 mutation carriers. RRSO should include complete salpingectomy. Detailed histopathological examination of specimens removed during RRSO is essential. Cancer 2018;124:952-9. © 2018 American Cancer Society.

Histopathological Parameters in Pterygia and Significant Clinical Correlations.

Purpose:To evaluate the clinical and histopathological parameters of pterygium to determine significant correlations between parameters that can affect management strategies.Methods:A total of 47 pterygia were clinically examined and excised for histopathological evaluation of epithelial and stromal changes. Some samples were immunostained with P53 (a protein of 53 kilodalton used as dysplastic epithelial marker), CD20 (CD/cluster of differentiation, are group of surface receptors providing targets for cellular immunophenotyping, CD20 as a B lymphocyte marker), CD 3 (as T lymphocyte marker) or vascular endothelial growth factor (VEGF/as vascular marker).Results:Most patients were male (59.6%). Cosmetic complaints (83%), grade II redness (61.7%), grade 2 extension (63.8), and associated astigmatism of <2.5 D (83%) were observed. Histopathological features included solar elastosis (100%), squamous hyperplasia (83%), increased stromal vascularity with hemorrhage (76.6%), and lymphocytic stromal infiltration, perivascular distribution, and mild epithelial lymphocytic exocytosis in 72.3%, 74.5%, and 70.2% of cases, respectively. Other changes included goblet cell hyperplasia (31.9%), prominent epithelial pigmentation (48.9%), and, most importantly, epithelial atypia (53.2%). Clinical redness was significantly correlated with vascularity, epithelial hyperplasia, and lymphocytic stromal infiltration; lymphocytic stromal infiltration was also significantly correlated with pterygium extension and with low astigmatism.Conclusion:The inflammatory response was mild in most cases and the density was not significantly correlated with any clinical parameter. Vascularity was related to clinical redness. Treatment with anti-VEGF may be beneficial, even for grade 1 pterygia that are not dominantly fibrotic.

Abrasive cytohistology of squamous epithelial lesions

Objective: To describe a method to retrieve cellular and tissue elements of oral squamous epithelium obtained by abrasive methods and to conduct investigations by cytohistology. Method: We developed a special gelatine pocket suitable for paraffin embedding of sparse material obtained from brush biopsies (BBs). This was subjected to combined evaluation of a cytological (smear) and histological examination of the ‘tissue sections’ – referred as cytohistology. Four diagnostic categories were applied for evaluation. Other special diagnostic methods were also applied in addition to recording dysplasia. Results: A total of 51, 755 BBs from suspicious lesions of the oral mucosa (mostly oral potentially malignant disorders – OPMD) were evaluated for the presence of carcinoma or dysplasia; in all, 1.7% were positive, 78.2% were negative for any epithelial atypia, 16.8% atypical and 3.3% inadequate. All BBs also had cytohistological evaluation. A ‘positive’ diagnosis by cytohistology was a reliable indicator of dysplasia or carcinoma, requiring further incisional/excisional biopsy. In the ‘atypical’ category, a variety of lesions were found, about half being dysplasia or carcinoma. This category challenges the clinician for further clinical, therapeutic and/or excisional examination. In ‘negative’ cases with persistence of the lesion, a re-examination in 1-year sequence is recommended. Conclusion: Cytohistology of material derived by abrasive methods allows earlier detection of dysplasia/carcinoma. A number of additional oncological and non-oncological findings make this method a valuable non-invasive diagnostic procedure for oral mucosal lesions.

Suspicious amorphous microcalcifications detected on full-field digital mammography: correlation with histopathology.

ObjectiveTo evaluate suspicious amorphous calcifications diagnosed on full-field digital mammography (FFDM) and establish correlations with histopathology findings.Materials and MethodsThis was a retrospective study of 78 suspicious amorphous calcifications (all classified as BI-RADS® 4) detected on FFDM. Vacuum-assisted breast biopsy (VABB) was performed. The histopathological classification of VABB core samples was as follows: pB2 (benign); pB3 (uncertain malignant potential); pB4 (suspicion of malignancy); and pB5 (malignant). Treatment was recommended for pB5 lesions. To rule out malignancy, surgical excision was recommended for pB3 and pB4 lesions. Patients not submitted to surgery were followed for at least 6 months.ResultsAmong the 78 amorphous calcifications evaluated, the histopathological analysis indicated that 8 (10.3%) were malignant/suspicious (6 classified as pB5 and 2 classified as pB4) and 36 (46.2%) were benign (classified as pB2). The remaining 34 lesions (43.6%) were classified as pB3: 33.3% were precursor lesions (atypical ductal hyperplasia, lobular neoplasia, or flat epithelial atypia) and 10.3% were high-risk lesions. For the pB3 lesions, the underestimation rate was zero.ConclusionThe diagnosis of precursor lesions (excluding atypical ductal hyperplasia, which can be pB4 depending on the severity and extent of the lesion) should not necessarily be considered indicative of underestimation of malignancy. Suspicious amorphous calcifications correlated more often with precursor lesions than with malignant lesions, at a ratio of 3:1.

Self-perceived oral health status and cytomorphological changes in individuals with addictive oral habits: assessed by WHO oral health questionnaire for adults

Background: Oral diseases related to tobacco use are relatively widespread and common in the Pakistani community but epidemiological data regarding maintenance of oral hygiene and suggested treatment is scarce. Therefore, this study was conducted in an under developed district (Muzaffargarh) of Punjab, Pakistan to evaluate oral health status and to determine frequency of cytomorphological changes in buccal mucosa of habitual tobacco users. Methods: Oral examination of all the subjects was carried out using mouth mirrors and gauze under good illumination. Cytology samples were taken from buccal mucosa. The smears were later stained with Papanicolaou stain and microscopy was performed. All the cytological data was recorded in the respective proformas. Data was analysed using IBM SPSS software version 20. Descriptive statistical analysis was performed. A p value of ≤0.05 was considered significant. Results: When cross relations were studied among the demographics, addictive habits and cytological variables, soft drink usage was associated with epithelial atypia (p=0.05), marijuana usage was associated with inflammatory infiltrate on cytology (p=0.047) and snuff/niswar usage was associated with inflammatory atypia (p=0.048). No associations were found among the other studied variables. Conclusions: The results of cellular changes in the smears from subjects with addictive habits can be utilized as an educational and screening tool in cessation therapy. The results attained in this study proposed that tobacco addictive habits produce cellular modifications in clinically normal mucosa on exfoliation cytology.

Flat epithelial atypia: conservative management of patients without residual microcalcifications post-vacuum-assisted breast biopsy.

To determine the malignancy rate (defined in this study as stability or absence of malignancy developed on close imaging follow-up post-biopsy) of conservative management in patients with a vacuum-assisted breast biopsy (VAB) diagnosis of flat epithelial atypia (FEA), performed on single group of microcalcifications, completely removed during procedure. This is a retrospective, monocentric, observational study, approved by IRB. Inclusion criteria were: VAB performed on a single group of microcalcifications; the absence of residual calcifications post-VAB; diagnosis of isolated FEA as the most advanced proliferative lesion; radiological follow-up at least of 12 months. The personal history of breast cancer or other high-risk lesions was an exclusion criteria. The patients enrolled were conservatively managed, without surgical excision, through close follow-up: the first two mammographies performed with an interval of 6 months after biopsy, followed by annual mammographic and clinical checks. 48 consecutive patients were enrolled in the study, all females, with age range of 39-76 years (mean 53,3 years) and radiological follow-up range of 13-75 months (mean 41.5 months). All the lesions were classified as BI-RADS 4b. The diameter range of the group of calcifications was 3-10 mm (mean 5, 6 mm). In each patient, 7 to 15 samples (mean 11) were obtained. Among all the patients, there was only one case (2%) of new microcalcifications, developed in the same breast, 26 months after and 8 mm from the site of previous VAB, and interpreted as ADH at surgical excision. All the checks of the other patients were negative. Even with a limited follow-up, we found a malignancy rate lower than 2%, through a defined population. Further studies with bigger number of patients and extended follow-up are needed to reinforce this hypothesis. Advances in knowledge: Surgical excision may not be necessary in patients with VAB diagnosis of isolated FEA, without residual microcalcifications post-procedure and considered concordant with the mammographic presentation, considering the low rate of malignancy at subsequent follow-ups.