Needle Biopsy Cases Research Articles

The Application of Intraoperative Ultrasound with Burr Hole Probe in Minimally Invasive Diagnosis and Treatment in Neurosurgery

ObjectiveTo summarize the preliminary application experience of intraoperative ultrasound with burr hole probe in minimally invasive neurosurgery and to explore its application value. Methods31 patients who underwent intraoperative ultrasound guided puncture with burr hole probe in our center from August 2018 to May 2024 were collected, including 16 cases of ventriculoperitoneal shunt operation, 6 cases of assisted stereotactic needle biopsy, 3 cases of intracranial pressure probe implantation in lateral ventricle, 3 cases of brain abscess puncture for external drainage, and 3 cases of intracranial cyst puncture and peritoneal drainage. During the procedures, the burr hole probe was used to locate the intracranial targets and guide the puncture. The postoperative CT scans or combined postoperative pathological results could verify the accuracy of puncture. In addition, the intervention effect and recovery status of patients were also recorded. ResultsThe intraoperative ultrasound with burr hole probe could clearly display all the purposed targets and accurately guide the puncture procedures in all cases. All patients achieved satisfactory diagnostic and therapeutic results without new neurological dysfunction and serious complications. ConclusionsThe intraoperative ultrasound with burr hole probe is an effective device for demonstrating intracranial structures. It not only enables minimally invasive and precise diagnosis or treatment of many neurosurgical diseases, but also is simple and safe to operate, which has important promotional value in the neurosurgery.

High-Grade Desmoplastic Foamy Gland Prostatic Adenocarcinoma.

It is important to recognize high-grade foamy gland prostatic adenocarcinoma with desmoplastic stroma given its aggressive clinical course with frequent metastases and death. To review the morphology, immunohistochemistry, and prognosis for this rare subtype of prostate adenocarcinoma. Twenty-four cases received for consultation from 2010 to 2021 were analyzed including needle biopsy (n = 21), transurethral resection (n = 2), and a cystoprostatectomy (n = 1). Patients ranged in age from 40 to 89 years (mean, 67 years). On average, 8 cores per case were involved (mean 67% core involvement). Extraprostatic extension and seminal vesicle invasion were observed in 6 of 21 (29%) and 3 of 21 (14%) needle biopsy cases, respectively. Twenty of the 24 cases (83%) were Grade Group (GG) 5 with 4 of 24 (17%) being GG4. Tumor necrosis as a component of Gleason pattern 5 was observed in 21 of 24 cases (88%). Associated intraductal adenocarcinoma (IDC) was observed in 22 of 24 cases (92%), with 4 of 24 cases (17%) demonstrating extensive IDC. Diagnostic challenges were as follows: (1) sparse isolated cancer glands embedded in the dense desmoplastic stroma; (2) fragmented glands; and (3) aberrant staining for high-molecular-weight cytokeratin in a nonbasal cell pattern in all cases. PTEN loss was observed in 9 cases, and p53 nuclear accumulation was observed in 8 cases. Three patients were lost to follow-up. Overall, of the 16 patients with meaningful follow-up, 12 (75%) either had metastases or died from prostate cancer. High-grade desmoplastic foamy gland adenocarcinoma is difficult to diagnose and grade and has a poor prognosis.

Thyroid diagnostic modalities (fine needle aspiration and core needle biopsy) with histology correlation: a tertiary centre experience

AimsTo determine the proportion of thyroid fine needle aspiration (FNA) and core needle biopsy (CNB) cases reported at a single institute into each UK Royal College of Pathologists (RCPath) Thy1-5...

Association of Ki-67 With Clinicopathological Factors in Breast Cancer.

BackgroundCarcinoma of the breast is one of the most common cancer in females, with preponderance among urban females. The patient's age, tumor size, lymph node status, histological type, histological grade, lymphovascular invasion, hormonal receptor status, human epidermal growth factor receptor 2 (Her2neu) expression, and Ki-67 labeling index for proliferation rate can help determine the appropriate management strategy in these patients. The authors conducted this descriptive retrospective study to assess the association of Ki-67 with clinicopathological parameters in a newly established institute. This may help guide treatment planning in developing countries.MethodologyPatients diagnosed with primary breast cancer in our institute between January 2017 and March 2020 were included in this study. The clinicopathological prognostic factors were retrieved from the records.ResultsA total of 129 cases of core needle biopsy and mastectomy specimens were included in this study. The patient's mean age and median age were 47.41 and 47 years, respectively. Only 56 specimens of mastectomy were received. T2 (26/56) was the most common tumor size. Grading was done in 46 cases, and grade 2 (23/46) was the most common. Estrogen, progesterone, and Her2neu were positive in 65, 61, and 59 cases, respectively. Only estrogen receptor (ER) expression (p = 0.035) and Her2neu (p = 0.035) overexpression were significantly correlated with Ki-67.ConclusionsKi-67 expression was correlated with clinicopathological factors. Only ER expression and Her2neu overexpression were significantly associated with Ki-67. Hence, patients with high Ki-67 expression may have better responses to hormonal therapy and chemotherapy.

Acute prostatitis after prostate biopsy under ciprofloxacin prophylaxis with or without ornidazole and pre-biopsy enema: analysis of 3.479 prostate biopsy cases.

ABSTRACTObjectives:To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive factors.Materials and Methods:We retrospectively reviewed the medical records of 3.479 cases of transrectal ultrasound-guided needle biopsies performed with different prophylactic antibiotherapy regimens at two different institutions between January 2011 and February 2016. The patients of Group I have received ciprofl oxacin (n=1.523, 500mg twice daily) and the patients of Group II have received ciprofl oxacin plus ornidazole (n=1.956, 500mg twice daily) and cleansing enema combination as prophylactic antibiotherapy. The incidence, clinical features and other related microbiological and clinical data, were evaluated.Results:Mean age was 62.38±7.30 (47-75), and the mean prostate volume was 43.17±15.20 (21-100) mL. Of the 3.479 patients, 39 (1.1%) developed acute prostatitis after the prostate biopsy procedure. Of the 39 cases of acute prostatitis, 28/3.042 occurred after the first biopsy and 11/437 occurred after repeat biopsy (p=0.038). In Group I, 22 of 1.523 (1.4%) patients developed acute prostatitis. In Group II, 17 of 1.959 (0.8%) patients developed acute prostatitis. There was no statistical difference between the two groups according to acute prostatitis rates (X2=2.56, P=0.11). Further, hypertension or DM were not related to the development of acute prostatitis (P=0.76, X2=0.096 and P=0.83, X2=0.046, respectively).Conclusions:Repeat biopsy seems to increase the risk of acute prostatitis, while the use of antibiotics effective for anaerobic pathogens seems not to be essential yet.

Primary mucinous carcinomas of the lung: Clinical characteristics and treatment outcomes.

Introduction:Invasive mucinous adenocarcinoma (IMA) of the lung is a distinct histologic variant of adenocarcinomas comprising about 2%–10% of lung adenocarcinomas. A large proportion of IMAs carry KRAS mutations and only rarely epidermal growth factor receptor (EGFR) mutations or ALK/ROS translocations; thus, most cases are not amenable for targeted therapy at present. This study was conducted to elicit the unique clinicopathological characteristics of IMA.Materials and Methods:Medical records of patients diagnosed with IMA by needle biopsy at Kidwai Cancer Institute, Bangalore, from 2013 to 2018, were retrieved and reviewed. Statistical analysis was performed using SPSS version 23.0 (IBM Corp., Armonk, NY, USA).Results:Four hundred and ninety cases of needle biopsy of the lung were diagonosed at our institute between January 2013 and December 2018. Nine cases (1.8%) were diagnosed as IMA. The median age of presentation was 59 years. Six (66.7%) were current smokers with pack-year > 20. Three (33.3%) of the cases were initially misdiagnosed as pneumonia in view of computed tomography findings. The lung was the most common site of metastasis (77.8%). Serum Carcinoembryonic Antigen (CEA) was elevated in six cases (66.7%). None of the cases had any driver mutations in EGFR gene or ALK and ROS1 translocations. All cases were treated with pemetrexed–carboplatin doublet followed by pemetrexed maintenance till progression. The median progression-free survival (PFS) was 15 months (range: 5–18 months). Docetaxel was given as the second-line chemotherapy in all progressed patients. Best response noted was stable disease, seen in 4 (57.1%) cases. The median PFS for docetaxel was 6 months (range: 3–8 months). The median overall survival was 22 months (range: 9–27 months). Patients with initially raised CEA at progression had a serial rise in serum CEA.Conclusions:IMA is rarely diagnosed on needle biopsies due to insufficient tissue. They mimic pneumonia on imaging, thus delaying diagnosis. EGFR mutations, ALK, and ROS1 translocations are usually negative making them ineligible for tyrosine kinase inhibitors. Response to chemotherapy is modest.

The Role of Chronic Inflammation in Prostate Carcinogenesis: A Follow-Up Study

Purpose To investigate the role of chronic inflammation in prostatic carcinogenesis with an emphasis on cancers of grade group 2 or above. Methods The presence/absence and extent of chronic inflammation and other relevant pathological findings were assessed using prostate needle biopsies obtained from patients with clinical parameters with suspicion of malignancy. In patients with no prior prostate cancer, follow-up biopsies were reviewed and correlated with the initial pathological findings. Results Of 1,006 prostate needle biopsy cases accessioned over 3 years at our institution, the initial biopsies of 244 cases were identified with no evidence of prostate cancer. These cases were divided into two subsets, including 202 cases with and 42 without chronic inflammation. Pathological findings assessed in this subset included post-atrophic hyperplasia, proliferative inflammatory atrophy, and high-grade prostatic intraepithelial neoplasia (HGPIN). Post-atrophic hyperplasia and proliferative inflammatory atrophy were noted only in patients with chronic inflammation. HGPIN was identified in 22 of the initial biopsy cases, specifically in 21 (10.3%) cases with inflammation and one case (2.4%) without inflammation. In follow-up biopsies, 70 patients (34.7%) with chronic inflammation were found to have prostatic adenocarcinoma with Gleason pattern 3 + 3 (42.9%; grade group 1), Gleason pattern 3 + 4(24.3%; grade group 2), Gleason pattern 4 + 3 (10%; grade group 3) and Gleason scores of 8 or higher (22.8%; grade groups 4 or 5), whereas cancer was found in 10 patients (23.8%) without chronic inflammation in the initial biopsy. Patients whose initial biopsies were benign and without inflammation did not show evidence of high-grade cancer (Gleason score of 8 or higher). Closely encroaching inflammation was observed more frequently in cancers of grade group 2 or above (76.5%, 13/17) compared with grade group 1 (50.0%, 3/6). Conclusions Our findings provide additional data supporting a role for chronic inflammation in the development of prostatic adenocarcinoma.

Percent Gleason pattern 4 in stratifying the prognosis of patients with intermediate-risk prostate cancer.

The Gleason score remains the most reliable prognosticator in men with prostate cancer. One of the recent important modifications in the Gleason grading system recommended from the International Society of Urological Pathology consensus conference is recording the percentage of Gleason pattern 4 in the pathology reports of prostate needle biopsy and radical prostatectomy cases with Gleason score 7 prostatic adenocarcinoma. Limited data have indeed suggested that the percent Gleason pattern 4 contributes to stratifying the prognosis of patients who undergo radical prostatectomy. An additional obvious benefit of reporting percent pattern 4 includes providing critical information for treatment decisions. This review summarizes and discusses available studies assessing the utility of the percentage of Gleason pattern 4 in the management of prostate cancer patients.

Aspek Histopatologik Adenokarsinoma Prostat

<p><strong>Introduction: </strong>Prostate carcinoma is the second most common tumor in male, 95% in which made up from adenocarcinoma. The diagnosis of prostate adenocarcinoma through a needle biopsy specimen plus the determination of tumor staging are paramount in selecting the therapy and management. This study is done to know the morphologic variation of prostate adenocarcinoma in the needle biopsy as well as to measure the grading compatibility between the needle biopsy and prostatectomy using Gleason scoring system.</p><p><strong>Materials and Method: </strong>This retrospective study is conducted through form and specimen slides compilement. The specimens, consisting of prostate adenocarcinoma’s needle biopsy and prostatectomy, were gathered from the archives of Pathological Anatomy Departement, Faculty of Medicine, University of Indonesia in the year of 2008-2013. The slides were re-read and the morphologic appearance’s variation was valued. Gleason scoring was also executed from the pairing specimen according to <em>International Society of Urological Pathology</em> (ISUP) 2010.</p><p><strong>Result: </strong>Out of 114 needle biopsy cases, the morphologic variation was found to be perineural invation (n=38), mucinous fibroplasia (n=1), glomerulation (n=1), mucinous basophilic (n=25), and eosinophilic crystal (n=5). The amount of patient that was performed both specimen is 11, and there is a compatibility between biopsy score and prostatectomy as much as 63.63% and the median is 7.</p><p><strong>Conclusion: </strong>It is requisite to know the morphological variation in prostate adenocarcinoma in the biopsy needle specimen to get an accurate diagnosis. Undergrading in biopsy specimen is as much as 36.36%, owing to the fact that prostate carcinoma can be manifested as mutifocal lesion, thus the higher grading can only be found in prostatectomy specimen, for the needle biopsy was inadequately taken.</p><p><strong>Keywords: prostate adenocarcinoma, morphological view, Gleason score</strong></p>

A Simple and Effective Method for Flow Cytometric Study of Lymphoid Malignancies Using Needle Core Biopsy Specimens.

We developed a simple and effective rinsing technique (RT) of needle biopsies to produce cell suspensions for flow cytometry (FCM) and evaluated whether the RT is comparable to the conventional tissue cell suspension (TCS) technique. We retrieved 93 needle core biopsy cases employing the RT for FCM and 25 needle biopsy cases using TCS for FCM. The diagnostic concordance between the FCM results and the morphologic diagnoses of both groups was compared. The diagnostic concordance was comparable in the RT group (92.6%) to the TCS group (71.4%). Furthermore, the diagnostic concordance in the RT group was associated with number of isolated cells. The diagnostic accuracy increased significantly when the cell number was above 30,000 in the RT group. The RT for FCM not only maximizes the tissue utilization, but also is a simple and effective method to obtain cell suspension as compared to traditional cell suspension technique. © 2018 International Clinical Cytometry Society.

Utility of Pathology Imagebase for standardisation of prostate cancer grading.

Despite efforts to standardise grading of prostate cancer, even among experts there is still a considerable variation in grading practices. In this study we describe the use of Pathology Imagebase, a novel reference image library, for setting an international standard in prostate cancer grading. The International Society of Urological Pathology (ISUP) recently launched a reference image database supervised by experts. A panel of 24 international experts in prostate pathology reviewed independently microphotographs of 90 cases of prostate needle biopsies with cancer. A linear weighted kappa of 0.67 (95% confidence interval = 0.62-0.72) and consensus was reached in 50 cases. The interobserver weighted kappa varied from 0.48 to 0.89. The highest level of agreement was seen for Gleason score (GS) 3 + 3 = 6 (ISUP grade 1), while higher grades and particularly GS 4 + 3 = 7 (ISUP grade 3) showed considerable disagreement. Once a two-thirds majority was reached, images were moved automatically into a public database available for all ISUP members at www.isupweb.org. Non-members are able to access a limited number of cases. It is anticipated that the database will assist pathologists to calibrate their grading and, hence, decrease interobserver variability. It will also help to identify instances where definitions of grades need to be clarified.

Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review

Optimal management of high-risk breast lesions detected by mammogram yielding atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar without atypia on core needle biopsy is controversial. This is a single-institution retrospective review of 5750 core needle biopsy cases seen over 14.5 years, including 249 (4.3%), 72 (1.3%), 50 (0.9%), 37 (0.6%), and 54 (0.9%) cases of atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar without atypia, respectively. Patient age, radiologic characteristics, needle gauge, and excision diagnoses were recorded. Of 462 high-risk cases analyzed, 333 (72%) underwent excision. Upgrade rate to ductal carcinoma in situ, pleomorphic carcinoma in situ, or invasive mammary carcinoma was 18% for atypical ductal hyperplasia, 11% for flat epithelial atypia, 9% for atypical lobular hyperplasia, 28% for lobular carcinoma in situ, and 16% for radial scar. Carcinoma diagnosed on excision was more likely to be in situ than invasive, and if invasive, more likely to be low grade than high grade. Overall, cases that were benign (vs high risk or carcinoma) on excision were less likely to have residual calcifications after biopsy (17% vs 27%, P=0.013), and more likely to have a smaller mass size (<1 cm) (82% vs 50%, P=0.001). On subgroup analysis, atypical ductal hyperplasia cases that were benign (vs high risk or carcinoma) on excision were more likely to have smaller mass size (<1 cm) (P=0.025). Lobular neoplasia diagnosed incidentally (vs targeted) on core needle biopsy was less likely to upgrade on excision (5% vs 39%, P=0.002). A comprehensive literature review was performed, identifying 116 studies reporting high-risk lesion upgrade rates, and our upgrade rates were similar to those of more recent larger studies. Careful radiological–pathological correlation is needed to identify high-risk lesion subgroups that may not need excision.

Percutaneous ultrasound-guided core needle biopsy of solid pancreatic masses: Results in 250 patients.

To determine the diagnostic accuracy and complications of percutaneous sonographic (US)-guided core needle-needle biopsy in the diagnosis of solid pancreatic masses. Cases of US-guided percutaneous core needle biopsy of solid pancreatic masses performed in our department between July 2009 and June 2015 were analyzed retrospectively. The demographic data, lesions' size and location, pathology results, accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and complications of the biopsies were determined. A total of 250 patients (150 males, 100 females; age range, 16-88 years; mean age, 64.3 ± 12.1 years) were included in the study. The overall diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of all 250 biopsies were 94.8%, 94.3%, 97.2%, 99.5%, and 75%, respectively, and changed to 98.4%, 99%, 94.7%, 99%, and 94.7%, respectively, after the biopsy was repeated in 12 patients. Four (1.6%) major complications, including a pseudoaneurysm of the gastroduodenal artery, and three cases of acute pancreatitis, and one (0.4%) minor complication (a vaso-vagal syncope), were observed. There was no biopsy-related death. US-guided percutaneous core needle biopsy is a safe and highly effective method with acceptable complication rates in the diagnosis of solid pancreatic masses. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:470-473, 2016.

Utility of touch imprint cytology as an adjunct to core needle biopsy of breast lump

Background: Touch imprint cytology is an easy and rapid method of evaluation of cancers. It can be utilized as a rapid intraoperative method and on site evaluation of biopsy specimen. Aim: to evaluate the efficacy of touch imprint cytology in assessment of adequacy of needle core biopsy of breast lumps its diagnostic accuracy for malignancy. Material and methods: A total of 160 cases of core needle biopsies of breast lump were studied. In each case touch imprint were made and a cytological diagnosis was offered on site. The results were correlated with the final biopsy diagnosis. Results: Adequate and satisfactory material on touch imprint was obtained in 154 (96.3%) cases.A total of 132 (82.5 %) cases were diagnosed as malignant and 21 (13.1 %) cases were diagnosed as benign on touch imprint cytology. Three cases (1.9%) were inconclusive, as the cells were obscured with inflammatory cells or there were crush artefacts. Overall sensitivity of TIC was 98.3 %, specificity was 70.3 %, positive predictive value was 93.8 %, negative predictive value was 90.4 % and accuracy was 90.2%. In 135 (88.2%) cases, a specific diagnosis regarding the exact histological subtype of the breast lesion could be provided. Conclusions: Touch imprint cytology of core needle biopsy specimens of breast lump yields adequate and satisfactory diagnostic material. It can be used routinely at the site of biopsy to evaluate the adequacy of material obtained during core needle biopsy. Touch imprints gives rapid and fairly accurate diagnosis of malignancy and subtyping of tumor is also possible. Key words: breast lump, core needle biopsy, touch imprint cytology, accuracy

Abstract P5-03-02: What is the optimal diagnostic approach for small breast lesions? Fine needle aspiration cytology vs. Vacuum-assisted core needle biopsy

Abstract [Background] Although advanced imaging technology enables us to detect small breast lesions, it remains a challenge whether it is a benign or malignant tumor with imaging findings alone. A definitive diagnosis is required with cytological or pathological diagnosis under ultrasonography guidance. Excessive examinations and malpractice are also concerned with increased examinations. The purpose of the study was to identify the optimal diagnostic approach for small breast lesions.[Patients and Methods] We reviewed a total of 1532 cases of ultrasonography-guided vacuum-assisted core needle biopsy (VAB) performed at a single institution between June 1996 and December 2013. There were 519 small breast lesions (274 non-palpable lesions and 245 non-mass lesions). Ultrasonographic examinations were performed on a LOGIC 500 (GE Healthcare, Waukesha, WI, USA) using an 11 MHz linear transducer before November 2011, and on Aplio MX (TOSHIBA, Minato, Tokyo, Japan) using an 8 MHz linear transducer since then. We performed VAB under ultrasonography guidance using 11-gauge probes (Mammotome Biopsy system; Biopsys Medical Inc., Irvine, CA, USA) for diagnosis and 8-gauge probes for excision of the lesion.[Results] The mean age of the 519 patients was 52.7 years. Ultrasonography-guided fine needle aspiration cytology (FNAC) was performed before VAB in 269 cases (51.8%). The FNAC revealed 76 malignant, 23 suspected malignant, 92 indeterminate, 47 benign or normal, and 31 inadequate cases. Of these FNAC results, the final pathological diagnosis was benign in 2 of 76 malignant and 6 of 21 suspected malignant cases, and malignant in 4 of 47 benign cases. Accordingly, the true positive, true negative, false positive, and false negative rates for the 146 cases (excluding the indeterminate and inadequate cases) by FNAC were 95.8%, 84.3%, 15.7%, and 4.2%, respectively. The pathological results of the VAB specimens were malignant in 229 and benign in 290 cases. Of the 290 cases classified as benign by VAB, we performed post-VAB excisional biopsy in 20 cases. The reasons for this second pathological examination were malignant or suspicious findings for malignancy by FNAC (8 cases), inconsistent imaging and FNAC findings (5 cases), and others (7 cases). Excisional biopsy revealed malignancy in 3 of these 20 cases. Furthermore, we re-performed VAB in 9 out of the original 290 cases, and these were all diagnosed benign as with the first VAB. Excision of the lesion was the primary reason for the second VAB (6 cases), followed by inconsistencies with the imaging findings (2 cases), and suspected malignancy by FNAC (1 case). The true positive, true negative, false positive and false negative rates of VAB were 98.7%, 100%, 0%, and 1.3%, respectively. The mean follow-up duration was 43 months. [Conclusion] To prevent the excessive examinations, FNAC should be excluded from the initial diagnostic approach for small breast lesions. VAB is a highly reliable technique as the initial diagnosis for small breast lesions with high true positive and true negative rates and a very low false positive rate. The optimal strategy for diagnostic procedures should be adopted in consideration of reducing stress and anxiety in patients and costs. Citation Format: Satoko Nakano, Masahiko Otsuka, Akemi Mibu, Toshinori Oinuma. What is the optimal diagnostic approach for small breast lesions? Fine needle aspiration cytology vs. Vacuum-assisted core needle biopsy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-03-02.

Inter-Institutional Pathology Consultation: The Importance of Breast Pathology Subspecialization in a Setting of Tertiary Cancer Center.

Inter-institutional pathology consultation (IPC) has shown to be significant in patient care. The purpose of the study was to evaluate the impact of IPC for breast biopsies in our institution. A total of 502 consecutive consult cases of breast core needle biopsies were reviewed. The original pathology reports from the referring institutions and our reports were compared for all cases. All cases were reviewed by specialized breast pathologists. Discordance was divided into minor and major based on the impact on patient care. We reviewed the subsequent excisional biopsy for all discordant cases. Discordance was seen in 104 (20.7%) cases; 40 (8%) had a major discordance and 64 (13%) had a minor discordance. Subsequent surgical excision was available for 25 (62.5%) cases with major discordance and for 13 (20.3%) with minor discordance. Our interpretation changed management in 15 (3%) patients, while 25 (5%) had a potential of management change. The cases with major discordance could be subcategorized into five groups, malignant 5 (12.5%), premalignant 16 (40%), biomarkers 10 (25%), fibroepithelial lesions 6 (15%), and others 3 (7.5%). Our findings support the value of IPC review in decreasing the likelihood of diagnostic errors that may lead to significant impact on patient care. It is necessary that outside pathology material in the referral settings been reviewed by a specialized breast pathologist.

Evaluation of early clinical experience of a novel prognostic proteomics prostate cancer biopsy test.

88 Background: Standard clinical and pathological parameters derived from diagnostic biopsy are insufficient to accurately assess final prostate tumor pathology of patients with biopsy Gleason grades 3+3 or 3+4. We developed a novel assay (ProMark) that performs quantitative measurements of 8 protein markers from prostate biopsy FFPE sections. In the validation study, assay risk scores were strongly predictive of final prostate tumor pathology with a C-stat of 0.69 (95%CI = 0.63 – 0.76) (p&lt;0.0001). By design, the train-test (N=381) and validation (N=274) studies were enrichment studies, with a higher % of aggressive disease than in the intended use population. Here we study 293 needle biopsy cases that have come to our CLIA lab for ProMark testing over a four month period. The objective of this study is to establish the ProMark score distribution for these ‘real world’ clinical use patients, and to confirm that this distribution matches our clinical validation study. Methods: To establish prevalence of aggressive disease in the intended use population, we used the Institutional Urology Prostate Cancer Database at Johns Hopkins. Among 9,305 men with biopsy Gleason 3+3 or 3+4 and prostatectomy from 2004-2014 the distribution of favorable (GS&lt;4+3 &amp; organ confined) and unfavorable (GS≥4+3 or non-organ confined) based on surgical pathology is 73.1% vs. 26.9%. The adjusted risk score distribution from the validation trial (N=274) is then compared to the CLIA lab samples (N=293), based on cumulative distributions and binomial confidence intervals. Results: Comparison of the risk score distribution of early clinical data with the population-adjusted validation score distribution shows good agreement based on 95% CIs. Table shows expected and measured frequencies in Low, Intermediate and High risk categories. The K-S test for comparison of distributions has p-value=0.44, supporting equivalence of distribution. Conclusions: The results of our study show that early clinical practice closely matches expectations from controlled clinical studies. [Table: see text]

Semantic analysis of SNOMED CT for a post-coordinated database of histopathology findings.

ObjectiveThis research investigated the use of SNOMED CT to represent diagnostic tissue morphologies and notable tissue architectures typically found within a pathologist's microscopic examination report to identify gaps in expressivity of SNOMED CT for use in anatomic pathology.Methods24 breast biopsy cases were reviewed by two board certified surgical pathologists who independently described the diagnostically important tissue architectures and diagnostic morphologies observed by microscopic examination. In addition, diagnostic comments and details were extracted from the original diagnostic pathology report. 95 unique clinical statements were extracted from 13 malignant and 11 benign breast needle biopsy cases.Results75% of the inventoried diagnostic terms and statements could be represented by valid SNOMED CT expressions. The expressions included one pre-coordinated expression and 73 post-coordinated expressions. No valid SNOMED CT expressions could be identified or developed to unambiguously assert the meaning of 21 statements (ie, 25% of inventoried clinical statements). Evaluation of the findings indicated that SNOMED CT lacked sufficient definitional expressions or the SNOMED CT concept model prohibited use of certain defined concepts needed to describe the numerous, diagnostically important tissue architectures and morphologic changes found within a surgical pathology microscopic examination.ConclusionsBecause information gathered during microscopic histopathology examination provides the basis of pathology diagnoses, additional concept definitions for tissue morphometries and modifications to the SNOMED CT concept model are needed and suggested to represent detailed histopathologic findings in computable fashion for purposes of patient information exchange and research.Trial registration numberUNMC Institutional Review Board ID# 342-11-EP.

Pseudohyperplastic Adenocarcinoma of the Prostate

A 60-year-old man underwent radical prostatectomy after a needle biopsy diagnosis of adenocarcinoma of the prostate with Gleason score 3 þ 3 1⁄4 6 in 4 of 12 cores. Sections of radical prostatectomy tissue showed areas with a somewhat nodular growth of complex glands resembling benign prostatic hyperplasia (fig. 1). This proliferation represents an uncommon variant of usual acinar adenocarcinoma of the prostate known as pseudohyperplastic adenocarcinoma, so called because the light microscopic appearance can simulate that of epithelial hyperplasia in the prostate. This variant, along with other deceptively benign appearing variants (atrophic and foamy gland adenocarcinomas), constitutes a large percentage of needle biopsy cases misdiagnosed as benign. There are no known clinical, radiological or gross features specific for pseudohyperplastic prostatic adenocarcinoma. Microscopically, pseudohyperplastic adenocarcinoma shows papillary infolding (fig. 2), luminal undulations and branching, and cystic dilatation. Pseudohyperplastic prostatic adenocarcinoma in the whole gland may be localized

Foamy Gland Carcinoma of the Prostate in Needle Biopsy

Foamy gland carcinoma is a variant of prostatic acinar adenocarcinoma characterized by abundant, foamy cytoplasm, frequently showing small, pyknotic nuclei. The incidence and Gleason grade of foamy gland carcinoma in a large prostate needle biopsy series have not been established. Foamy gland carcinoma may be deceptively benign appearing and missed on needle biopsy. Immunohistochemical staining for basal cells and α-methylacyl-CoA racemase (AMACR) can support a diagnosis of foamy gland carcinoma, but the sensitivity of AMACR for foamy gland carcinoma has been reported to be lower than that for usual acinar carcinoma. The utility of ERG immunohistochemistry in the diagnosis of foamy gland carcinoma has not been explored. The aim of this study was to characterize the incidence and Gleason grade of foamy gland carcinoma in a large consecutive series of prostate needle biopsy cases. We also assessed ERG expression in foamy gland carcinoma, in comparison with AMACR expression, to determine whether ERG expression provides added diagnostic value beyond AMACR expression. We evaluated a consecutive series of 476 prostatic adenocarcinoma needle core biopsy cases for presence, linear extent, and Gleason grade of foamy gland carcinoma. A selected block from each case containing foamy gland carcinoma was evaluated for AMACR and ERG expression by immunohistochemistry. Of the 476 cases, 17% contained a foamy gland carcinoma component, with 2% of the cases showing pure foamy gland carcinoma. Two cases of pure foamy gland carcinoma had a total linear extent of <3 mm. The majority (80%) of cases had a Gleason score 3+3=score of 6. Sensitivity of AMACR for foamy gland carcinoma was 92%, and sensitivity of ERG was 42%. No AMACR-negative case was ERG positive. Low AMACR expression was detected in 24 of 72 cases (33%), and of these cases ERG was positive in 5 (21%). In summary, foamy gland carcinoma features are relatively common in prostate needle core biopsies, the foamy gland carcinoma is admixed with usual acinar carcinoma in the majority of cases, and is usually not of high Gleason grade, although 20% are Gleason score 7 or greater. ERG immunohistochemistry did not provide added value beyond AMACR expression in most cases, suggesting that it need not be initially utilized in addition to basal cell markers and AMACR when immunohistochemistry is needed to substantiate a diagnosis of foamy gland malignancy. This is an important consideration in this era of cost-consciousness in application of immunohistochemistry. Sensitivity of AMACR for foamy gland carcinoma was comparable to that seen in studies of usual acinar carcinoma and is an excellent marker for foamy gland carcinoma of the prostate. ERG immunohistochemistry could be considered in a second round of immunostaining of select difficult cases of foamy gland carcinoma with low AMACR expression.