Preoperative Biopsy Results Research Articles

Can the Cartilaginous Thickness Determine the Risk of Malignancy in Pelvic Cartilaginous Tumors, and How Accurate is the Preoperative Biopsy of These Tumors?

Can the Cartilaginous Thickness Determine the Risk of Malignancy in Pelvic Cartilaginous Tumors, and How Accurate is the Preoperative Biopsy of These Tumors?

Upgrade Rate of Ductal Carcinoma In Situ to Invasive Carcinoma and the Clinicopathological Factors Predicting the Upgrade Following a Mastectomy: A Retrospective Study.

Background The rate of upgrading ductal carcinoma in situ (DCIS) to invasive cancer varies widely in the literature with no consensus regarding sentinel lymph node biopsy (SLNB) for DCIS; however, some guidelines do recommend it in the event of a mastectomy. The primary aim of this study was to determine the upgrade rate of DCIS to invasive carcinoma (IC) in patients undergoing mastectomy for DCIS and identify the clinicopathological predicting factors for the upgrade. The secondary aim was to determine the SLNB positivity rate. Methodology We retrospectively analysed consecutive patients with DCIS diagnosed through a biopsy who then underwent mastectomy over a 10-year period (2010 to 2020). Clinical, radiological, and histological variables were collected from medical records. Results We studied 143 women (mean age = 57.4 years, range = 26-85 years) who underwent mastectomy for DCIS identified on biopsy.Almost two-thirds (62.9%, 90/143) of the patients were detected on screening mammography, while 35.6% (51/143) were diagnosed following presentation with either an area of palpable concern or nipple discharge.The most common mammographic presentation of DCIS was calcification (83.9%, 120/143), and, in 85.9% of the patients, the mammographic lesion was more than 20 mm. High-grade DCIS was noted in 76.9% of preoperative biopsy results, while the rest was either low or intermediate-grade DCIS. Overall, 24.5% (35/143) were upgraded to IC (upgraded group) on postoperative histology, whereas 108/143 remained DCIS postoperatively (pure DCIS group).The positivity rate of SLNB was 4.8%. Multifocality was the only significant predictor of IC on multivariate analyses of clinicopathological predictors (odds ratio = 3.0, 95% confidence interval = 1.0-8.7). The presence of comedonecrosis was higher in the upgraded group compared to the pure DCIS group (42.9% vs. 27.8%), but this was not statistically significant. Conclusions In our study cohort, nearly one in four (24.5%) patients were upgraded from DCIS to IC on postoperative histology, with an SLNB positivity rate of 4.8%. This is important when counselling patients regarding the risk of coincident occult IC and the importance of SLNB at the time of mastectomy. Multifocality on preoperative imaging was the only significant predictive factor. Based on this result, we recommend that SLNB should also be considered if patients have multifocal DCIS and planned for oncoplastic breast-conserving surgery. However, further studies are required to investigate the association between multifocal DCIS and the risk of upgrading to IC.

Clinicopathological characteristics and outcomes of malignant adenomyoepithelioma of the breast: a single institution\u2019s experience

BackgroundMalignant adenomyoepithelioma of the breast is a rare tumor and most of relevant literature consists of individual case reports. This study objective was designed to evaluate clinicopathological features and treatment outcomes of 15 cases of malignant adenomyoepithelioma at a single institute.MethodsA retrospective medical record review was performed for 15 subjects confirmed with malignant adenomyoepithelioma upon postoperative pathological diagnosis at the Asan Medical Center from January 2008 to June 2018. Data regarding age at diagnosis, preoperative biopsy results, operation methods, the status of hormone receptors and HER2, and clinical outcomes were collected.ResultsAll cases were female patients diagnosed at median age of 50 years. Preoperative core needle biopsy results showed that 40% of the cases (6 out of 15) were benign which was in discordance with the final malignant pathology report. Thirteen cases underwent wide excision with or without sentinel lymph node biopsy (SLNB) and 2 cases had total mastectomy with SLNB. Five of 11 cases (45.5%) were triple negative. Ten of 15 cases underwent postoperative radiation therapy, 3 cases underwent chemotherapy, and 5 cases underwent endocrine therapy. During median follow-up of 55 months, the 5-year overall survival rate was 87.5% and the 5-year disease free survival rate was 91.7%. Two lung metastases developed. One case showed local recurrence 3 years after surgery and radiotherapy and subsequently developed lung metastasis 1 year late. Another case developed lung metastasis one and a half years after surgery in combination with endocrine therapy and neoadjuvant chemotherapy.ConclusionPreoperative core needle biopsy showed inaccurate results for diagnosing malignant adenomyoepithelioma. Malignant adenomyoepithelioma has a high rate of triple negative subtype but has a relatively good prognosis although there is a risk of local and systemic recurrence.

Laparoscopic surgery experience does not influence oncological and functional results of robotic-assisted laparoscopic prostatectomy.

Surgery is one of the treatment alternatives for prostate cancer, and robotic-assisted laparoscopic prostatectomy (RALP) has become the new trend in the past decade. There is no consensus yet for surgeons who will perform RALP whether they need to be trained or experienced in laparoscopy. In this study, it was aimed to investigate the effectiveness of the surgeon's laparoscopy experience in the perioperative and postoperative results of RALP patients. Patients who underwent RALP were retrospectively screened. The first 20 cases done by surgeons in both groups and 40 cases in total were included in the study. Surgeons with laparoscopy training were designated as group 1, and surgeons without laparoscopy training were designated as group 2. Patient's age, preoperative prostate-specific antigen (PSA) value, prostate biopsy pathology, radical prostatectomy pathology, surgical margin positivity, extracapsular extension, and seminal vesicle invasion status, blood transfusion rate, operation time, length of hospital stay, and 1-year follow-up potency and urinary incontinence rates were compared. There was no difference between the two groups in terms of age, preoperative PSA, preoperative biopsy results, blood transfusion rates, operation times, and the length of hospital stay of the patients. When the postoperative oncological and functional results of the patients were examined, there was no difference between the two groups in the prostatectomy pathology (p = 0.895), extracapsular extension (pT3a) (p = 0.519), positive surgical margin (pSM) (p = 0.723), and seminal vesicle invasion (pT3b) (p = 0.756). Potency and urinary incontinence rates were similar in both groups at the end of one year follow-up (p = 0.327, 0.500 respectively). Based on our study, it is clearly seen that regardless of the surgeon's experience of laparoscopy, it can be safely preferred when looking at the oncological and functional results of RALP.

Efficacy and safety of endoscopic papillectomy of major duodenal papilla neoplasms

Objective: To discuss the efficacy and safety of endoscopic papillectomy of major duodenal papilla neoplasms. Methods: The clinical-pathological data of 21 patients who were admitted to the Department of Endoscopy, Cancer Hospital, Chinese Academy of Medical Sciences and underwent endoscopic papillectomy of major duodenal papilla neoplasms from January 2014 to January 2020 were retrospectively studied, their postoperative outcomes and complication were also analyzed. Results: Tweenty-one patients were successfully performed endoscopic papillectomy of major duodenal papilla neoplasms. The resected lesions varied between 0.5-2.8 cm. Completed lesion was resected in 19 cases and lesion blocks in 2 cases. The incidence of postoperative complication was 52.4% (11/21), including 8 cases of postoperative bleeding (38.1%). Five patients stopped bleeding after endoscopic hemostasis and 3 patients stopped after interventional embolization. Two patients experienced perforation (9.5%) and recovered after conservative treatment including anti-inflammatory treatment and abdominal drainage. Five patients had pancreatitis (23.8%) and recovered after treatment with pre-somatostatin and anti-inflammatory rectal suppository. Preoperative pathological results of 21 patients suggested that 11 were high-grade intraepithelial neoplasia and 8 were low-grade intraepithelial neoplasia, and 2 were chronic inflammation. Postoperative pathological results suggested that 4 were adenocarcinoma, and the rest 17 were adenoma. The coincidence rate of preoperative biopsy results and postoperative pathology was 38.1%(8/21), and underestimate of the pathological stage occurred in 11 patients (52.4%) during the preoperative biopsy, overestimate occurred in two patients (9.5%). Four cases had a positive incisal margin. All patients had good prognoses and no death event occurred during the follow-up period. Conclusions: Early-stage major duodenal papilla neoplasms should be treated with aggressive resection. Endoscopic papillectomy of duodenal papilla neoplasms is safe, effective, and can be recommended as the preferred procedure for major duodenal papilla neoplasms.

Histopathological validation of magnifying endoscopy for diagnosis of mixed-histological-type early gastric cancer.

BACKGROUNDThe undifferentiated-type (UDT) component profoundly affects the clinical course of early gastric cancers (EGCs). However, an accurate preoperative diagnosis of the histological types is unsatisfactory. To date, few studies have investigated whether the UDT component within mixed-histological-type (MT) EGCs can be recognized preoperatively.AIMTo clarify the histopathological characteristics of the endoscopically-resected MT EGCs for investigating whether the UDT component could be recognized preoperatively.METHODSThis was a single-center retrospective study. First, we attempted to clarify the histopathological characteristics of the endoscopically-resected MT EGCs with emphasis on the UDT component. Histopathological examination investigated each lesion’s UDT component: (1) Whole mucosal layer occupation of the UDT component; (2) UDT component exposure to the surface of the mucosa; and (3) existence of a clear border between the differentiated-type and UDT components. Then, preoperative endoscopic images with magnifying endoscopy with narrow-band imaging (ME-NBI) were examined to identify whether the endoscopic UDT component finding was recognizable within the area where it was present in the histopathological examination. The preoperative biopsy results and comparative relationships between endoscopic and histopathological findings were also examined.RESULTSIn the histopathological examination, the whole mucosal layer occupation of the UDT component and exposure of the UDT component to the mucosal surface were observed in 67.3% (33/49) and 79.6% (39/49) of samples, respectively. A clear distinction of the border between the differentiated-type and UDT components could not be drawn in 65.3% (32/49) of MT lesions. In the endoscopic examination, the preoperative endoscopic images showed that only 24.5% (12/49) of MT EGCs revealed the UDT component within the area where it was present histopathologically. Histopathological UDT predominance was the single significant factor associated with the presence of the endoscopic UDT component finding (61.5% vs 11.1%, P = 0.0009). Only 26.5% (13/49) of the lesions were diagnosed from the pretreatment biopsy as having a UDT component. Combined results of the pretreatment biopsy and ME-NBI showed the preoperative presence of the UDT component in 40.8% (20/49) of MT EGCs.CONCLUSIONRecognition of a UDT component within MT EGCs is difficult even when pretreatment biopsy and ME-NBI are combined. Endoscopic resection plays a significant role in both treatment and diagnosis.

The Reliability of Intraoperative Assessment on Predicting Tumor Size, Myometrial Invasion, and Cervical Involvement in Patients With a Preoperative Diagnosis of Complex Atypical Hyperplasia or (Clinical Stage I) Endometrial Cancer: A Prospective Cohort Study.

The objective of this study is to assess the reliability of intraoperative uterine assessment compared with the final pathologic evaluation in patients with endometrial cancer (EC) and whether assessment improves with experience. After Institutional Review Board approval, a prospective cohort study of women surgically managed with biopsy-proven complex atypical hyperplasia (CAH) or EC between March 2015 and December 2016 was performed. Demographics, preoperative biopsy results, procedure, intraoperative and final pathologic evaluation of lesion size, myometrial invasion, and lower uterine segment/cervical involvement were abstracted. The agreement between the intraoperative and final pathologic evaluation of tumor involvement of the uterus was determined using the kappa statistic and the intraclass correlation coefficient. A total of 264 patients with a preoperative diagnosis of CAH or EC were included-71 (26.9%) with CAH and 193 (73.1%) with EC. The mean age was 62.6±11.5, and mean body mass index was 37.2±10.1. The majority of women were white (67%). A total of 227 (85.9%) patients underwent a laparoscopic or robotic hysterectomy, whereas 36 (13.6%) underwent an abdominal hysterectomy. 233 (88.3%) patients had EC and 21 (7.9%) patients had CAH on final pathology. There was a fair agreement between the intraoperative estimation of myometrial invasion (κ=0.37). A moderate agreement exists between the intraoperative estimation of lower uterine segment/cervical involvement (κ=0.57). There was a strong agreement between intraoperative tumor size assessment and the final path (intraclass correlation coefficient=0.74). The intraoperative correlation of tumor size was similar for the first half of the cohort (κ=0.50) and the second half (κ=0.46) chronologically. Despite only a fair correlation in the myometrial invasion, intraoperative assessment of cervical involvement and especially tumor size is more readily identified and overall accurate. Therefore, intraoperative evaluation is an additional tool to use when making the decision to proceed with surgical staging.

Surgical significance and efficacy of epidermal growth factor receptor tyrosine kinase inhibitors in patients with primary lung adenosquamous carcinoma.

BackgroundPrimary adenosquamous carcinoma (ASC) of the lung is a rare and aggressive disease. The accurate diagnosis of ASC based on small biopsies is challenging because of the mixed components within the tumor, and this may lead to suboptimal treatment. Furthermore, information about the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in lung ASC is limited.Patients and methodsData on a cohort of patients with lung ASC who underwent surgery between October 2008 and December 2016 at a single institution were retrospectively reviewed.ResultsThis study analyzed 148 patients. Differences between the pre- and post-resection diagnosis were observed. Based on the results of preoperative biopsy, patients were diagnosed as having squamous cell carcinoma (n=26), adenocarcinoma (n=20), poorly differentiated carcinoma (n=20), and large cell carcinoma (n=1), and finally diagnosed as having ASC based on histopathological examination of the surgical specimens. Thirty patients (20.3%) with EGFR-sensitizing mutations (TKI group) were treated with EGFR-TKIs after surgery, whereas the remaining patients (79.7%) with unknown EGFR-mutation status received chemotherapy or chemoradiotherapy alone (non-TKI group). TKI treatment was associated with better median overall survival (OS) (HR=0.619; p=0.034). Multivariate analysis identified the presence of EGFR-TKI treatment as an independent prognostic factor for OS (HR=0.471; p=0.003).ConclusionDiscrepancies between the pre- and post-operative diagnosis reflect the inadequacy of non-resection approaches to the diagnosis of ASC. ASC patients harboring EGFR-sensitizing mutations who were treated with EGFR-TKIs showed a significantly better prognosis than those receiving chemotherapy or chemoradiotherapy alone.

Complete pathological response after neoadjuvant therapy in patients with rectal adenocarcinoma

BackgroundColorectal cancer is the fourth most common cancer and the second leading cause of death from cancer in the United States. Preoperative neoadjuvant therapy (chemotherapy and radiotherapy) is the gold standard in the management of rectal cancer before surgical resection. The literature includes reports of absence of neoplastic cells after neoadjuvant therapy. There are no reports on complete pathological response to this type of therapy in Mexico. ObjectivesDetermine the percentage of patients with rectal adenocarcinoma with complete pathological response after neoadjuvant therapy. All patients were treated in a colorectal surgery department of a tertiary care hospital. Materials and methodsA total of 64 patients with rectal adenocarcinoma diagnosed by biopsy were treated from January 2010 to December 2015. Demographic data, tumour localisation, pathological report, TNM stage, neoadjuvant therapy, surgical procedure and postoperative pathological report were collected from patient records. ResultsMean patient age was 52.8 years (range of 26–73); 31 were women and 33 men. Twenty-seven patients (27) were stage II and 27 stage III. The preoperative biopsy results were classified as: well differentiated (10); moderately differentiated (48); and poorly differentiated/undifferentiated adenocarcinoma (6). Twenty patients received neoadjuvant therapy (31.2%). In these, 2 tumours were localised in the upper third of the rectum, 6 in the middle third, and 12 in the lower third. Six patients underwent abdominoperineal resection, 10 total mesorectal excision, and four posterior pelvic exenteration. Six patients undergoing neoadjuvant therapy had a complete pathological response. ConclusionsThe percentage of patients with a complete pathological response is similar to that in other literature reports. More evidence is needed to define good prognosis factors in patients who might not require surgery after neoadjuvant therapy.

Solitary fibrous tumour of pleura: CT differentiation of benign and malignant types

To analyse and compare the computed tomography (CT) features of benign and malignant types of histopathologically proven cases of solitary fibrous tumours of pleura (SFTP). Retrospective analysis of preoperative CT images of 28 cases of histopathologically proven and classified SFTP from three participating institutions was performed. Patient demographics and lesion characteristics including size, borders, presence of a pedicle, extension into the fissure, attenuation, enhancement, pleural effusion, and calcifications were recorded and correlated with the final histopathological diagnosis. Type and results of preoperative biopsy were also recorded. Follow-up imaging and the clinical charts were reviewed to identify recurrence. Out of 28 cases (15 women and 13 men), 18 were proven to be benign and 10 were malignant. The mean age of patients was 58.1±15.9 and 66.5±11.8 years (p=0.1564) for benign and malignant tumours, respectively. The median (interquartile range) diameter was 6.05 (3.2-10.9) cm for benign and 15.7 (7.1-17.5) cm for malignant type tumours (p=0.0291). Tumours had lobulate borders in 28% (5/18) of benign cases and in 80% (8/10) of malignant cases (p=0.0163). Extension into adjacent fissure was seen in 22% (4/18) of benign lesions and 40% (4/10) of malignant lesions (p=0.40). A pedicle was present in 17% (3/18) of benign and 10% (1/10) of malignant lesions (p=1). Heterogeneous attenuation was present in 61% (11/18) of benign and 90% (9/10) of malignant lesions (p=0.19). Calcification was present in 17% (3/18) of benign tumours and in 70% (7/10) of malignant tumours (p=0.0113). Pleural effusion was present in 6% (1/18) of benign and 40% (4/10) of malignant lesions (p=0.04). Only 1/13 preoperative fine-needle aspirates yielded diagnosis of SFTP. Preoperative diagnosis of SFTP was made in all cases (11/11) with core biopsies. At follow-up (1-10 years, mean 3 years), local recurrence occurred in 3/6 (50%) patients with malignant SFTP and in none of the 10 patients with benign SFTP. No definite imaging feature to differentiate benign from malignant SFTP was found. Large size, lobulate borders, presence of calcification, and ipsilateral pleural effusion were the only CT features predictive of malignancy. In suspected cases, core biopsies should be performed rather than fine-needle aspiration.

Postreperfusion hyperkalemia in liver transplantation using donation after cardiac death grafts with pathological changes

With the increasing use of donation after cardiac death (DCD), especially of the graft liver with steatosis or other pathological changes, the frequency of postreperfusion hyperkalemia in liver transplantation has increased significantly. The present study aimed to determine the factors associated with developing postreperfusion hyperkalemia in liver transplantation from DCD. One hundred thirty-one consecutive adult patients who underwent orthotopic liver transplantation from DCD were retrospectively studied. Based on serum potassium within 5 minutes after reperfusion, recipients were divided into two groups: hyperkalemia and normokalemia. According to preoperative biopsy results, the DCD graft livers were classified into five categories. Univariate analysis was performed using Chi-square test to identify variables that were significantly different between two groups. Multivariate logistic regression was used to confirm the risk factors of developing hyperkalemia and postreperfusion syndrome. Correlation analysis was used to identify the relationship between the serum concentration of potassium within 5 minutes after reperfusion and the difference in mean arterial pressure values before and within 5 minutes after reperfusion. Twenty-two of 131 liver recipients had hyperkalemia episodes within 5 minutes after reperfusion. The rate of hyperkalemia was significantly higher in recipients of macrosteatotic DCD graft liver (78.6%, P<0.001) than that in recipients of non-macrosteatotic DCD graft liver. The odds ratio of developing postreperfusion hyperkalemia in recipients of macrosteatotic DCD graft liver was 51.3 (P<0.001). Macrosteatosis in the DCD graft liver was an independent risk factor of developing hyperkalemia within 5 minutes after reperfusion. The highest rate of postreperfusion syndrome also occurred in the recipients with macrosteatotic DCD graft liver (71.4%, P<0.001). A strong relationship existed between the serum potassium within 5 minutes after reperfusion and the difference in mean arterial pressure values before and within 5 minutes after reperfusion in macrosteatotic DCD graft liver recipients. Macrosteatosis in the DCD graft liver was an independent risk factor of developing hyperkalemia and postreperfusion syndrome in the recipients.

Surgery for undiagnosed ground glass pulmonary nodules: decision making using serial computed tomography.

Although long-term observation of ground glass nodules on computed tomography facilitates the ability to distinguish malignant lesions from benign lesions, the resulting treatment delay can increase the rate of cancer recurrence. We reviewed our surgical cases of pathologically undiagnosed lung nodules possessing ground glass to clarify the clinical impact of selecting surgical candidates based on serial computed tomography, not preoperative biopsy results. A consecutive series of 100 patients with clinically suspected lung cancer possessing ground glass among our prospective database of 262 surgical cases of suspected lung cancer were retrospectively reviewed. Surgical indication was determined based on the interval change in the outer diameter or internal attenuation of the lesions in 53 patients (increasing lesions), while that was determined based on the specific marginal or internal features of the lesions in 47 patients (non-increasing lesions). The length of preoperative follow-up was significantly longer in the patients with increasing lesions than in the patients with non-increasing lesions (27 vs. 3 months, P < 0.001). The final pathological diagnoses consisted of 97 adenocarcinomas and three non-malignant lesions. All increasing lesions were adenocarcinomas. Surgical biopsy contributed in avoiding futile lobectomy in patients with non-malignant lesions, while that caused false-negative result in one patient with an increasing lesion. Postoperative recurrence occurred in two patients. In a surgical series, serial computed tomography-diagnosed ground glass lesions are highly suggestive of adenocarcinoma, especially increasing lesions. Despite spending a long-term preoperative follow-up period without a pathological diagnosis, the surgical outcome is satisfactory. Surgical biopsy for increasing lesions is generally futile.

Renal vein leiomyosarcoma: imaging and clinical features of a renal cell carcinoma mimic

Renal vein leiomyosarcoma is a rare tumor whose clinical and imaging features can significantly overlap with those of advanced primary renal neoplasms, particularly renal cell carcinoma. IRB approval was obtained for a retrospective review of clinical and imaging information for five patients with the pathologically proven diagnosis of renal vein leiomyosarcoma at two institutions. Among the five patients, two were female and three male; average age 58.6 (range 42-77). Three patients presented with flank or abdominal pain, one with pulmonary embolism, and one with weight loss and fatigue. Mass size ranged from 4 to 10cm. Four masses were left-sided and one right-sided. Tumors involved and expanded the renal vein in all cases, with tumor extension to the renal hilum in one case, through the renal hilum into renal parenchyma in two cases, and into inferior vena cava in two cases. All masses demonstrated contrast enhancement, which was solely peripheral in one case. In all cases, extrarenal tumor volume was greater than renal parenchymal tumor volume. When renal masses are predominantly or exclusively intravascular, consideration should be given to the diagnosis of renal vein leiomyosarcoma because preoperative biopsy results could significantly alter management.

Robotic Radical Prostatectomy at a Teaching Community Hospital: Outcomes and Safety

This study describes the early experience of robotic prostatectomy exclusively at a teaching community hospital. This is a retrospective report of 153 consecutive patients on whom 4 physicians were the operating surgeon. The average hospital stay was 1.5 days, the mean operative time was 175 minutes, and the estimated operative blood loss was <300mL. The perioperative complication rate was 7.8% (12/153). The prostate-specific antigen failure rate was 2% (2/114). Urinary continence was maintained in 98% of patients 9 months after surgery. Postoperative Gleason scores differed significantly from preoperative biopsy results (P<0.001). Pathological records reported positive margins in 35% (54/153) of specimens. T3 tumors had positive margins more than twice as often as T2 tumors (P<0.002). Surgeon experience correlated with shorter operative times (P=0.001), but not with positive margins. Increasing body mass index was associated with increased operating time (P<0.001). Robotic prostatectomy appears to be a safe and successful option for prostate cancer treatment in a teaching community hospital.

Percutaneous Biopsy of Renal Cell Carcinoma Underestimates Nuclear Grade

To assess the accuracy of renal biopsy for predicting the final nuclear grade and histologic subtype. Small renal masses can be safely observed in select patients who are poor surgical candidates. Renal biopsy may help identify patients who are candidates for observation. A total of 81 patients (29 female, 52 male) underwent percutaneous biopsy of their renal mass with ultrasound or computed tomography guidance. Percutaneous 18-gauge biopsy cores were obtained, and all patients subsequently underwent radical nephrectomy or partial nephrectomy. Preoperative biopsy results were compared with postoperative specimens. The mean tumor size was 5.3 cm (range, 1-17). Overall, biopsy correctly identified 71 of 81 (88%) histologic subtypes. The preoperative biopsy correctly identified 62 of 64 (97%) clear cell renal carcinomas, 9 of 10 (90%) papillary carcinomas, 0 of 3 (0%) chromophobe carcinomas, and 1 of 2 (50%) oncocytomas. The final pathologies for 2 nondiagnostic biopsies were clear cell renal carcinoma and inflammatory pseudotumor. For 67 tumors, the pathologists assigned a nuclear grade for both the biopsy and the final specimen. The biopsy correctly identified 29 of 67 (43%) final nuclear grades. The biopsy underestimated the nuclear grade in 37 of 67 (55%) cases. In 7 of 67 (10%) cases, the biopsy nuclear grade increased by 2 when compared with the final grade. The biopsy rarely overestimated the nuclear grade; 1 case (1%) that was assigned a grade 2 on biopsy was assigned a grade 1 after nephrectomy. Core biopsies for renal masses underestimate nuclear grade in most cases; however, histologic subtype is more reliably assessed, particularly for clear cell renal tumors.

Ductoscopy and intraductal vacuum assisted biopsy in women with pathologic nipple discharge

Fiberoptic ductoscopy is increasingly used to evaluate pathologic nipple discharge. A major limitation of this technique is the inability to obtain tissue samples from suspicious intraductal lesions. We present a novel technique for ductoscopic biopsy of intraluminal tumors. From 2002 to 2005 ductoscopy was performed in 38 women with nipple discharge using a rigid gradient index microendoscope (diameter 0.7 mm) and a special needle for intraductal vacuum assisted biopsy. Results of preoperative biopsy were correlated with the histology of the resection specimen Cannulation of the discharging duct was successful in 37 of 38 patients (97%). Intraductal lesions were diagnosed in 29 women (78%). The sensitivity of ductoscopy and galactography in the detection of intraductal lesion was comparable (96% vs. 89%). Ductoscopic biopsy of intraductal lesions was technically successful in all but one case. Generally, the quality of the biopsy samples was good. Diagnostic biopsy samples were obtained in 26 of 28 patients (93%). Two samples contained necrosis and were considered to be non-representative. Histological analysis of the biopsy specimens showed 22 papilloma, 2 in situ carcinoma and 2 invasive carcinoma. Histology of the resection specimens confirmed the diagnosis in all cases, but there was one case with additional carcinoma lobulare in situ. Ductoscopic vacuum assisted biopsy is a new technique for tissue sampling of intraductal breast lesions. This method may improve preoperative evaluation of pathologic nipple discharge in selected patients, but it should not be considered as a method for screening of early breast cancer.

Patterns and Significance of Peripheral Calcifications of Thyroid Tumors seen on Ultrasound

Purpose: We wanted to analyze the peripheral calcification patterns of thyroid tumors that were seen on ultrasound and we also wanted to evaluate the clinical usefulness of the peripheral calcifications of the thyroid tumors. Materials and Methods: We retrospectively analyzed 21 peripheral calcifications of the thyroid tumors of 18 patients; these were histopathologically confirmed by fine needle aspiration biopsy, automated gun biopsy and surgery. The peripheral calcification patterns were categorized into three types: type 1, peripheral nodular calcification, type 2, peripheral smooth rim calcification, and type 3, peripheral irregular rim calcification. The histopathologic results obtained during surgery, fine needle aspiration or automated gun biopsy were compared. Results: Of the total 21 peripheral calcifications of thyroid tumors, 5 cases showed as being type 1 (24%), 3 cases showed as being type 2 (14%) and 13 cases showed as being type 3 (62%). Of the total 21 peripheral calcifications of the thyroid tumors, 18 were histopathologically confirmed as papillary carcinoma (86%). Among the type 1 peripheral calcification patterns, 3 cases were coincidentally diagnosed as papillary carcinoma and 2 cases were follicular neoplasm on the preoperative biopsy results and on the surgical results. Two cases of type 2 peripheral calcifications (67%) and three cases of type 3 peripheral calcifications (23%) were diagnosed as benign lesions upon preoperative biopsy, but the postoperative results were papillary carcinoma. Conclusion: Peripheral calcifications of thyroid tumors are important feature that suggest malignancy together with the microcalcification and peripheral calcifications of the type 2 and type 3 patterns, and these lesions may be difficult to accurately diagnose with using only biopsy.

Trends in Reporting Gleason Score 1991 to 2001: Changes in the Pathologist's Practice

Objective: The prostate specific antigen (PSA) era has been associated with a grade migration towards moderately-differentiated (Gleason 5–7) prostate cancer. We investigated whether changes in interpretation of the Gleason system could be a contributing factor by reviewing the Gleason scores for prostate cancer in our region. Patients and Methods: Records of patients with prostate cancer assigned a Gleason score between 1991–2001 were retrospectively reviewed. We analysed trends in Gleason score, method of diagnosis and age at diagnosis. Following this, 50 cases from the dataset were randomly selected (stratified to contain half Gleason 2–4 reports) and reviewed in a blinded manner by an uropathologist and given a new Gleason score. Results: 2737 patients were diagnosed and given a Gleason score; 1484 by prostate biopsy (PB) and 1172 by transurethral resection of prostate (TURP). 273 radical prostatectomy (RP) specimens were received, although the results of pre-operative biopsies were available in only 192 of these patients. Over time, there was an increase in the proportion of patients with Gleason 5–7, and a significant decrease in reporting of Gleason 2–4 cancer ( r 2 = 0.81, p < 0.0001). In 1991, 24% of cancers were Gleason 2–4; in 2001 this had decreased to 2.4%. TURP was associated with more Gleason 2–4 reports (23%) compared with PB (13.2%) and RP (9.2%). On blinded review, all Gleason 2–4 reports were upgraded to Gleason 5–7 cancer ( p < 0.001). Conclusion: Over time, the proportion of Gleason 2–4 prostate cancer reported has significantly decreased. Our study suggests that a change in practice by the pathologist is a significant factor in this grade migration.

Management of lower lip cancer: a retrospective analysis of 118 patients and review of the literature.

In this current study, the clinical data and postoperative follow-up findings of 118 patients with a primary lower lip carcinoma who were treated between 1983 and 1999 in the Department of Plastic and Reconstructive Surgery are presented. Medical records were reviewed retrospectively and data were collected concerning age, gender, followup period, location of lesion on the lip, cervical metastasis at presentation, preoperative biopsy results, histological grade, initial treatment, reconstruction type, pathological outcome, local recurrence, regional lymph node metastasis, treatment of local recurrence and regional lymph node metastasis, and postoperative treatment. The prognostic value of clinical stages in relation with recurrence and mortality from disease was investigated. The overall rate of recurrence was calculated as being 39.8%, and the determinate survival rate was found to be 72.9% at 5-year follow-up. The data concerning the above-mentioned parameters, together with risk factors that might play a role in the development of lip cancer, are discussed in light of the current literature.

Management of Lower Lip Cancer

In Brief In this current study, the clinical data and postoperative follow-up findings of 118 patients with a primary lower lip carcinoma who were treated between 1983 and 1999 in the Department of Plastic and Reconstructive Surgery are presented. Medical records were reviewed retrospectively and data were collected concerning age, gender, followup period, location of lesion on the lip, cervical metastasis at presentation, preoperative biopsy results, histological grade, initial treatment, reconstruction type, pathological outcome, local recurrence, regional lymph node metastasis, treatment of local recurrence and regional lymph node metastasis, and postoperative treatment. The prognostic value of clinical stages in relation with recurrence and mortality from disease was investigated. The overall rate of recurrence was calculated as being 39.8%, and the determinate survival rate was found to be 72.9% at 5-year follow-up. The data concerning the above-mentioned parameters, together with risk factors that might play a role in the development of lip cancer, are discussed in light of the current literature. A review of 118 primary lower lip carcinomas, 43% presenting as stage IV, demonstrated a 39.8% recurrence rate and a 72.9% determinate 5-year survival rate.