Sensitivity For Detection Of Malignancy Research Articles

Prospective Validation of ThyroSPEC Molecular Testing of Indeterminate Thyroid Nodule Cytology Following Diagnostic Pathway Optimization.

Background: Molecular testing for cytologically indeterminate thyroid nodules (ITNs) is often reported with incomplete data on clinical assessment and ultrasound malignancy risk (USMR) stratification. This study aimed to clinically validate the diagnostic accuracy of a novel molecular test, assess the incremental preoperative malignancy risk of other clinical factors, and measure the impacts of introducing molecular testing at the population level. Methods: Comprehensive clinical data were collected prospectively for the first 615 consecutive patients with ITNs in a centralized health care system following implementation of a reflexive molecular test. Clinical data include patient history, method of nodule discovery, clinical assessment, USMR, cytology, molecular testing, and surgery or follow-up along with surgeon notes on surgical decision-making. Accuracy of molecular testing and the impact of the introduction of molecular testing were calculated. A multivariable regression model was developed to identify which clinical factors have the most diagnostic significance for ITNs. Results: A locally developed, low-cost molecular test achieved a negative predictive value (NPV) of 76-91% [confidence interval, CI 66-95%] and a positive predictive value (PPV) of 46-65% [CI 37-75%] in ITNs using only residual material from standard liquid cytology fine-needle aspiration (FNA). Sensitivity was highest (80%; [CI 63-92%]) in the American Thyroid Association (ATA) intermediate-suspicion ultrasound category, and lowest (46%; [CI 19-75%]) in the ATA high-suspicion ultrasound category. Following implementation of molecular testing, diagnostic yield increased by 14% (p = 0.2442) and repeat FNAs decreased by 24% (p = 0.05). Mutation was the primary reason for surgery in 76% of resected, mutation-positive patients. High-risk mutations were associated with a 58% (p = 0.0001) shorter wait for surgery. Twenty-six percent of patients with a negative molecular test result underwent surgery. Multivariable regression highlighted molecular testing and USMR as significantly associated with malignancy. Conclusions: Molecular testing improves preoperative risk stratification but requires further stratification for intermediate-risk mutations. Incorporation of clinical factors (especially USMR) with molecular testing may increase the sensitivity for detection of malignancy. Introduction of molecular testing offers some clinical benefits even in a low resection rate setting, and directly influences surgical decision-making. This study illustrates the importance of the local diagnostic pathway in ensuring appropriate integrated use of molecular testing for best outcomes.

Image-guided core needle biopsy for musculoskeletal lesions

BackgroundImage-guided percutaneous core needle biopsy (CNB) has been an important diagnostic procedure for musculoskeletal lesions. Here we surveyed the variety of diagnostic strategies available and assessed the clinical usefulness and limitations of image-guided CNB carried out by a multidisciplinary team comprising specialists in various fields. MethodsWe conducted a retrospective study of 284 image-guided CNBs among 1899 consecutive biopsy procedures carried out at our institution for musculoskeletal tumorous conditions, focusing on their effectiveness including diagnostic accuracy and utility for classification of specimens according to malignant potential and histological subtype as well as their correlation with biopsy routes. ResultsAmong the 284 studied biopsies, 252 (88.7%) were considered clinically “effective”. The sensitivity for detection of malignancy was 94.0% (110/117) and the specificity was 95.3% (41/43). The diagnostic accuracy for detection of malignancy was 94.4% (151/160) and that for histological subtype was 92.3% (48/52). The clinical effectiveness of the procedure was correlated with the complexity of the biopsy route (P = 0.015); the trans-pedicular, trans-retroperitoneal and trans-sciatic foramen approaches tended to yield ineffective results. Repeat biopsy did not have a significant impact on the effectiveness of image-guided CNB (P = 0.536). ConclusionsThe diagnostic accuracy rates of image-guided CNB performed at multidisciplinary sarcoma units were usable even for patients who have variety of diagnostic biopsy procedures. It is important to establish and implement diagnostic strategies based on an understanding that complicated routes, especially for spine and pelvic lesions, may be associated with ineffectiveness and/or complications.

Validación de los criterios ecográficos IOTA en la práctica clínica con marcadores tumorales y patología

Objetivos. Correlacionar la ecografía prequirúrgica de las masas anexiales aplicando los criterios IOTA y el diagnóstico anatomopatológico tras intervención quirúrgica. Valorar la utilidad de los marcadores tumorales bioquímicos. Método. Estudio observacional prospectivo en 102 pacientes con diagnóstico ecográfico de tumoración anexial, intervenidas quirúrgicamente entre enero 2017 y febrero 2020. El análisis estadístico se realizó con SPSS 17.0. Las variables categóricas se analizaron mediante pruebas de Fisher y chi-cuadrado, las variables cuantitativasmediante prueba t-student. La concordancia entre la valoración de la ecografía transvaginal mediante criterios IOTA y el resultado anatomopatológico, se estudió con el coeficiente de contingencia y el índice kappa. Resultados. Según criterios IOTA, se clasificó como benignas a 48% de las tumoraciones, como malignas 24,5%, y 27,5% resultaron no clasificables. La anatomía patológica confirmó que 68,1% de las benignas y 72,8% de las malignas fueron correctamente filiadas por la ecografía. La concordancia entre la ecografía transvaginal prequirúrgica y la anatomía patológica fue significativa, con coeficiente de contingencia 0,58, índice kappa 0,47, p <0,05 y con sensibilidad 94,1% y especificidad 92,1%. Los valores de la proteína epididimal humana 4 (HE4) y el antígeno del cáncer 125 (CA 125) tuvieron correlación con la anatomía patológica, también con significación estadística, siendo mayor en las pacientes menopáusicas. Conclusiones. Los criterios IOTA discriminaron de forma satisfactoria las masas benignas de las malignas. La proteína HE4 resultó mejor marcador bioquímico que el CA125.

Abstract 3339: Ethnic disparity in ovarian malignancy tumor markers: MIA and ROMA

Abstract Objective: Review and analyze serum values of Risk of Ovarian Malignancy Algorithm (ROMA) and Multivariate Index Assay (MIA) in subgroups of women who underwent surgery for adnexal masses to determine sensitivity in different ethnic populations. Methods: Serum samples from 179 women diagnosed with ovarian malignancy were analyzed for ROMA and MIA results. Biomarker data was obtained from previous prospective studies that validated the MIA test. Of these, 167 women were Caucasian (C) and 12 African-American (AA) in the MIA testing. Sample for ROMA included 161 C and 11 AA. Sensitivity (true positive rate) for preoperative test results were calculated using DTCompair package of the R programming language. In premenopausal women, a risk of ovarian malignancy algorithm (ROMA) value equal to or greater than 1.14 indicates a high risk of finding epithelial ovarian cancer. In premenopausal women, MIA values of greater than 5.0 are associated with greater risk of malignancy. In postmenopausal women, a ROMA value equal to or greater than 2.99 indicates a high risk of finding epithelial ovarian cancer. In postmenopausal women, MIA values of greater than 4.4 are associated with greater risk of malignancy. Results: Primary ovarian malignancy was diagnosed in 179 cases (167 C/12 AA). Sensitivity testing results are seen for each subgroup and for MIA levels and CA125 results: Primary Ovarian Malignancy: Caucasian MIA 97.0%, ROMA 89.4%, AA MIA 75.0% ROMA 45.5%. Sensitivity of ROMA in AA premenopausal women was 50% and in postmenopausal women 33.3 %. Conclusion: Our results demonstrate that ROMA in both C andAA women with adnexal masses have lower sensitivity for detection of malignancy than does MIA. It is more pronounced in AA women. Implementation of MIA in evaluation of adnexal masses will increase sensitivity of detection of malignancy compared to CA125 testing, with most marked results in AA women. Key Words: Ethnicity, CA125, and Multivariate Index Assay Sensitivity of MIA vs. ROMA Ovarian MalignancyRaceTestStatusMenopauseNumberSensitivityCaucasianMIAAll16797.0CaucasianMIAPre4395.3CaucasianMIAPost12497.6CaucasianROMAAll16189.4CaucasianROMAPre4092.5CaucasianROMAPost12188.4African AmericaMIAAll1275African AmericaMIAPre977.8African AmericaMIAPost366.7African AmericaROMAAll1145.5African AmericaROMAPre850.0African AmericaROMAPost333.3 Citation Format: Charles Dunton, Herbert Fritsche, Rowan Bullock. Ethnic disparity in ovarian malignancy tumor markers: MIA and ROMA [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3339.

Percutaneous image-guided core biopsy of solid renal masses: analysis of safety, efficacy, pathologic interpretation, and clinical significance.

To determine the efficacy, safety and clinical utility of CT and US-guided percutaneous renal mass biopsy. A retrospective IRB-approved, HIPAA-compliant study of a cohort of 183 consecutive patients who underwent percutaneous, CT or US-guided renal mass biopsy (RMB) from March 2002 through December 2012 was performed. RMB was performed in 183 consecutive patients for suspected solid renal mass of whom 14/183 (7.7%) were excluded because biopsies were performed at an outside institution, medical records were incomplete, or lesions were poorly visualized. Ten patients had multiple biopsies for new growing masses. Using US, CT or CT/US fusion-guidance, a 17G or 19G cannula needle was placed at the margin of the mass and an 18G or 20G core biopsy gun was used to obtain several tissue cores. Renal parenchymal biopsies for medical renal diseases were excluded. Imaging variables (including size, location, and extent of disease), number of core biopsies, patient demographics (age, gender), clinical indication, final pathologic diagnosis, immunohistochemical (IHC) studies, and subsequent final pathological diagnosis on nephrectomy were evaluated. Of the 169 patients with 184 RMB, 121/169 (71.6%) were male with a mean age of 67.5 years. Of 184 RMB, 126 were malignant [126/184 (68.5%)], 37 [37/184 (20.1%)], were benign, and 21 (21/184 (11.4%) were nondiagnostic. IHC was performed in 131 biopsies (71.1%) and was diagnostic in 88.5% of those cases. Twenty-eight patients underwent subsequent partial nephrectomy; in 27/27 (100%) cases, RMB was concordant with nephrectomy for malignancy and in 21/27 (77.8%) RMB was concordant for subtype of RCC. Overall, the RMB sensitivity for detection of malignancy, specificity, and positive predictive value were 100%. The negative predictive value of benign RMB diagnosis was also 100%. There was a total of 14 (7.6%) complications, 13 minor (7.1%) and 1 major (0.5%). Of the minor complications, ten (5.5%) were postprocedural minor hematomas that resolved conservatively; one (0.5%) postprocedural vasovagal reaction; one (0.5%) episode of hematuria; and one (0.5%) episode of nausea and abdominal discomfort. No cases of renal pseudoaneurysm or tumor seeding attributed to biopsy were identified. Percutaneous image-guided RMB is safe and highly diagnostic when combined with IHC and supports a greater role of RMB and imaging in evaluating renal masses when rendering appropriate treatments.

Randomized Comparison of Power Doppler Ultrasonography-Guided Core-Needle Biopsy with Open Surgical Biopsy for the Characterization of Lymphadenopathies in Patients with Suspected Lymphoma

BackgroundIn case of clinical suspicion of lymphoma, the histological examination of lymphadenopathy is essential for defining a correct diagnosis and for developing a proper treatment plan. An open surgical biopsy (OSB) is still the "gold standard", owing to the large amount of tissue obtained. The sensitivity of lymph node core-needle biopsy under imaging guidance requires validation.AimsThis randomized study compared the ultrasound-guided core-needle cutting biopsy (CNCB) approach with OSB approach.Patient and methodsInstitutional review board approval and informed consent were obtained. In a single center between 1 January 2009 and 31 December 2015, patients with lymph node enlargement suspected for lymphoma were randomly assigned (1:1) to biopsy with either OSB (standard group) or ultrasound-guided 16 gauge modified Menghini needle (core-needle group). In the core-needle group, the lymph node to undergone biopsy was determined by power Doppler US, in particular, the main criterion to select the node to be biopsied was the hypervascularization. The primary endpoint was to test the superiority of sensitivity for diagnosis of malignancy for ultrasound-guided CNCB compared with OSB. Secondary endpoints were negative predictive values, likelihood ratio of negative test, biopsy related complications, costs and times to biopsy.ResultsA total of 372 patients were randomized either to standard group (N= 187) or core-needle group (N= 185). Sensitivity for detection of malignancy was significantly better for US-guided CNCB [98.8%; 95% confidence interval (CI), 95.9-99.9] than standard biopsy [88.7%; 95% CI, 82.9-93] (P<0.001). Therefore, the study objective to show superiority of US-guided CNCB versus OSB was achieved, being the sensitivity rate of experimental approach significantly higher than standard approach. For all secondary endpoints, the comparison was significantly disadvantageous for standard approach. The negative predictive value was 50% (19 of 38; 95% CI, 33.4-66.6) for OSB and 84.6% (11 of 13; 95% CI, 54.5-98.1) for US-guided CNCB (P= 0.014). The negative likelihood ratio was 0.11 (95% CI: 0.07-0.17) for OSB and 0.01 (95% CI: 0.00-0.05) for US-guided CNCB, confirming the value of the US-guided CNCB for detecting malignancy. Patients who received standard biopsy had significantly more procedure-related complications (P<0.001). Furthermore, estimated cost per biopsy performed with standard surgery was 24-fold higher compared with that performed with US-guided CNCB (P<0.0001). The median waiting time for performance of biopsy (from procedure indication to perform itself), was 4 days with a range of 1 to 10 days in the core-needle group. By contrast, it was 16 days, with a range of 5 to 34 days in the standard group (P<0.0001).ConclusionsThis study is the first to compare in a randomized fashion the sensitivity of US-guided CNCB and OSB in detecting lymphoma. Power Doppler US and CNCB are diagnostic tools that enable effective, safe, fast and low-cost routine biopsy for patients with suspected lymphoma, avoiding psychological and physical pain of an unnecessary surgical intervention. We suggest this approach as first-line mini-invasive procedure for patients with a suspected lymphoma and not merely when surgical intervention is not possible, or to document relapse. DisclosuresNo relevant conflicts of interest to declare.

Diagnosis of focal liver lesions with gadoxetic acid‐enhanced MRI: Is a shortened delay time possible by adding diffusion‐weighted imaging?

To determine whether the diagnostic performance of combined gadoxetic acid-enhanced dynamic phases and diffusion-weighted imaging (DWI) is comparable to the standard protocol with hepatobiliary phase (HBP) and DWI for detection and characterization of focal liver lesions in chronic liver disease. A total of 176 patients with 181 HCCs, 15 cholangiocarcinomas, and 32 benign lesions were included. Three combined gadoxetic acid-enhanced and DWI sets (dynamic phases [arterial, portal, and 3-min delay {3-min set} and dynamic phases with 10-min HBP [10-min set] or 20-min HBP [20-min set]) were analyzed by two observers to determine the diagnostic accuracy and sensitivity in detection of malignancy, and ability for lesion characterization. There was a trend, although not statistically significant, toward highest diagnostic accuracy and sensitivity for detecting malignancies in the 20-min set (mean, 0.945, 96.2), followed by the 10-min set (0.937, 95.9), and the 3-min set (0.923, 94.1) (P > 0.05). For lesion characterization, three image sets were equivalent (P > 0.05). For lesion detection and characterization in chronic liver diseases, 3-min set with DWI showed comparable efficacy to 10-min or 20-min set. However, the best diagnostic performance could be achieved by combination of all image sets.

Bronchoscopic evaluation of the mediastinum using endobronchial ultrasound: a description of the first 216 cases carried out at an Australian tertiary hospital

Performance of linear probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for staging non-small-cell lung cancer has been extensively studied. Alternate indications for its use are less well characterised, and performance in other clinical settings may differ. We examined a prospectively collected cohort comprising the first 215 patients undergoing EBUS-TBNA at our institution. Patients were analysed according to the clinical and radiological indication for referral. We also examined the effect of the procedural learning curve on diagnostic sensitivity. A total of 215 patients underwent 216 EBUS-TBNA procedures. EBUS-TBNA returned adequate tissue for cytopathological analysis in 202 of 216 procedures (94%). Overall sensitivity for detection of malignancy was 0.92 (95% confidence interval 0.86-0.96); however, this varied according to the primary indication for EBUS-TBNA. Diagnostic sensitivity was high among all sub-groups, but the negative predictive value varied depending on the clinical indication for the procedure. We estimate 104 invasive surgical procedures and 32 inpatient admissions were avoided by use of EBUS-TBNA. Significant improvement in diagnostic performance was seen after 20 procedures were completed, and diagnostic accuracy did not peak until after 50 procedures. EBUS-TBNA is able to confirm accurately histologically a large number of disease processes, both malignant and benign, in all clinical indications studied. The procedure is safe even when carried out by proceduralists with minimal prior experience. Diagnostic performance continues to improve beyond 50 cases carried out.

Prospective Evaluation of Advanced Molecular Markers and Imaging Techniques in Patients With Indeterminate Bile Duct Strictures

Standard techniques for evaluating bile duct strictures have poor sensitivity for detection of malignancy. Newer imaging modalities, such as intraductal ultrasound (IDUS), and advanced cytologic techniques, such as digital image analysis (DIA) and fluorescence in situ hybridization (FISH), identify chromosomal abnormalities, and may improve sensitivity while maintaining high specificity. Our aim was to prospectively evaluate the accuracy of these techniques in patients with indeterminate biliary strictures. Cholangiography, routine cytology (RC), intraductal biopsy, DIA, FISH, and IDUS were performed in 86 patients with indeterminate biliary strictures. Patients were stratified based on the presence or absence of primary sclerosing cholangitis (PSC). RC provided low sensitivity (7-33%) but high specificity (95-100%) for PSC and non-PSC patients. The composite DIA/FISH results (when considering trisomy-7 [Tri-7] as a marker of benign disease) yielded a 100% specificity and increased sensitivity one- to fivefold in PSC patients versus RC, and two- to fivefold in patients without PSC, depending on how suspicious cytology results were interpreted. For the most difficult-to-manage patients with negative cytology and histology who were later proven to have malignancy (N = 21), DIA, FISH, composite DIA/FISH, and IDUS were able to predict malignant diagnoses in 14%, 62%, 67%, and 86%, respectively. DIA, FISH, and IDUS enhance the accuracy of standard techniques in evaluation of indeterminate bile duct strictures, allowing diagnosis of malignancy in a substantial number of patients with false-negative cytology and histology. These findings support the routine use of these newer diagnostic modalities in patients with indeterminate biliary strictures.

Biopsy of Indeterminate Biliary Strictures - Does Direct Visualization Help? - A Multicener Experience

Background & Aim: Endoscopic retrograde cholangiography (ERC)-guided brushings and biopsies of indeterminate biliary strictures have low sensitivity for detection of malignancy. Targeted biopsies under direct visualization by peroral cholangioscopy may improve diagnostic sensitivity of intraductal biopsies. Methods: As part of an international multicenter registry, 60 patients with indeterminate biliary strictures or filling defects underwent ERC followed by peroral cholangioscopy using SpyGlass Direct Visualization System (Boston Scientific, Natick, USA). This system includes a reusable optical probe and a disposable catheter with 4-way tip deflection, dedicated irrigation channels, and 1.2 mm working channel accommodating the disposable SpyBite biopsy forceps. Procedural success was defined as ability to visualize target lesion and obtain adequate biopsies for histology. Per protocol, patients with benign biopsies undergo 12 months of follow-up or until definitive diagnosis of malignancy is established, whereas those with biopsies consistent with malignancy undergo 1 month of follow-up. Approximately 50% of patients have 6 months of follow-up. Enrollment and follow-up are ongoing. Results: Indications for cholangioscopy with biopsy were indeterminate strictures in non-PSC patients (62%), dominant PSC strictures (14%), non-diagnostic prior tissue sampling (10%), indeterminate filling defects (7%), non-diagnostic prior ERC findings (2%), and other (5%). Biopsies were obtained in CBD (36%), Hilum (26%), CHD (24%), LHD (10%), and RHD (5%). Procedural success was achieved in 53/60 (88%) of patients. Ability to obtain biopsy was reported as good or excellent in 76%, fair in 20% and poor in 3% of cases. Mean number of biopsy attempts per patient was 4.4 and mean number of biopsies obtained per patient was 3.7. Amount of tissue obtained was deemed adequate in 87% of the cases. Sensitivity, specificity, PPV and NPV of biopsies for detection of malignancy in 29 patients who had at least 6 months of follow-up were 78%, 100%, 100% and 60% respectively. There were 5 deaths, none related to devices or ERC or cholangioscopy procedures. There were 8 serious device and/or procedure related adverse event, 6 resolved without sequelae and 2 are resolving: 2 cholangitis (3.3%), 2 bacteremia (3.3%), 1 liver abscess with sepsis and cholangitis (1.7%), 1 nausea (1.7%), 1 transient hypotension (1.7%), and 1 radiculopathy (1.7%). Conclusions: Targeted biopsies using SpyGlass DVS is feasible, safe and well tolerated. Biliary biopsies obtained under direct visualization by peroral cholangioscopy have high sensitivity for diagnosis of pancreatobiliary malignancies.

Fine Needle Aspiration Cytology of Lobular Breast Carcinoma

To analyze the detailed cytomorphology of lobular breast carcinoma and to compare the cytologic smears of benign, borderline and infiltrating duct carcinoma. Fine needle aspiration cytology (FNAC) smears of histopathologically proven infiltrating lobular carcinoma (ILC), infiltrating ductal carcinoma (IDC), borderline lesions and benign breast lesions were selected for study. Detailed cytomorphologic analysis of the smears was carried out on hematoxylin and eosin- and May-Grünwald-Giemsa--stained slides, and a comparison of results was done. The various cytologic features were also graded semi-quantitatively with the numerical score; logistic regression analysis was done. There were 25 cases of ILC, 30 of IDC, and 10 borderline and 18 benign lesions. Cytologic diagnosis of malignancy on FNAC smears of ILC was offered in 19 cases; of them, 2 cases were diagnosed as ILC. The remaining six cases were diagnosed as borderline (four) and benign lesions (two). Overall sensitivity in detection of malignancy in ILC cases was 76%. FNAC smears of ILC showed moderate (52%) to abundant (32%) cellularity. The cells of ILC were arranged both in clusters and in dissociation (72%). Individual cells were monomorphic (40%) to mildly pleomorphic (60%), and the cells were smaller. The cells showed a smooth, regular nuclear margin; bland chromatin; and indistinct nucleoli. Indian file arrangement was frequently observed (28%). Nuclear molding (28%) and intranuclear inclusions (16%) were also noted. Intracytoplasmic lumina were seen in occasional cases. Logistic regression analysis was carried out, and a comparison between lobular carcinoma and ductal carcinoma, and borderline and benign lesions was done. Logistic regression analysis of cytomorphologic features showed that cellularity and nuclear margin irregularities were the two most important features to distinguish ILC from IDC. In comparison to borderline lesions, cell dissociation was more common in ILC. The salient cytologic features that helped to distinguish ILC from benign lesions was cell size, cellularity, cell uniformity and chromatin pattern. There are overlapping cytologic features between ILC, IDC and borderline breast lesions on FNAC smears. Logistic regression analysis may be helpful in this regard.

Bladder biopsy using the flexible cystoscope: sensitivity in detection of malignancy

Bladder biopsy using the flexible cystoscope: sensitivity in detection of malignancy

Use of magnetic enrichment for detection of carcinoma cells in fluid specimens.

Ascites fluid or a pleural effusion are common events in metastatic carcinoma, but they also can be associated with several other medical conditions. The standard for determination of malignancy in these situations is cytologic evaluation of these fluids. Although this method is frequently successful, there are times when it fails, even when the patient has a malignancy, either because of insufficient cells in the fluid or for other reasons. This study addresses this problem taking advantage of the recent advances in technology for detection of rare epithelial cells in liquid specimens. The authors examined fluid specimens from 59 patients to determine the frequency of recovery of epithelial cells compared with that achieved by conventional cytopathology. The Dynal CELLection Epithelial Enrich (Dynal AS, Oslo, Norway) method was used. This method is based on immunomagnetic selection of cells binding to EpCAM antibodies. Carcinoma cells were confirmed by morphology and, when there was sufficient material, by E-cadherin staining. Grouping the cases by cytologic diagnosis, the authors found malignant cells using the cell enrichment assay in 11 of 12 malignant cases, 2 of 5 atypical cases, and 3 of 42 negative cases. Further investigations were conducted on the five cases that were cytologically negative or atypical but yielded epithelial cells after immunomagnetic enrichment. Four cases ultimately were proven malignant by other methods and one had incomplete follow-up. The new methods available for epithelial cell enrichment in liquids may be used successfully on cytologic fluid specimens and may lead to increased sensitivity for detection of malignancy, and consequently more accurate staging.

Stereotactic 14G Core Biopsy of Non-palpable Breast Cancer: What is the Relationship Between the Number of Core Samples Taken and the Sensitivity for Detection of Malignancy?

AIM: Percutaneous 14-gauge core biopsy (CB) guided by digital stereotactic mammography is now an established technique in the investigation of women with non-palpable suspicious mammographic lesions. Diagnostic sensitivity of CB is affected both by the nature of the mammographic abnormality and by the number of core samples taken.METHODS AND RESULTS: A retrospective review of 500 women who have undergone CB in our institution showed that in 235 cases, invasive or non-invasive carcinoma was found on final surgical histology. Correlation between CB result and surgical histology revealed a significant increase in sensitivity for the diagnosis of malignancy if a larger number of cores were taken (84.3% for two cores and 90.2% for five cores vs. 97.9% for six or more cores). This trend was maintained when patients were subdivided according to mammographic abnormality, either soft tissue mass or microcalcifications. The effect on diagnostic sensitivity of increasing the number of tissue cores obtained was most pronounced in patients with microcalcifications graded as low or moderately suspicious for malignancy (70.1% for two cores and 79.1% for five cores vs 94.0% for six or more cores). The presence of an invasive component in a malignant lesion was correctly diagnosed using CB in 79.2% overall if at least six cores were taken. If the mammographic lesion was a soft tissue mass, this figure rose to 95.7%, but was only 35.7% if the visible lesion was composed of microcalcifications alone.CONCLUSION: Our series confirms the reliability of stereotactic CB in the diagnosis of breast carcinoma. Diagnostic sensitivity is improved by increasing the number of cores taken (to six or more), particularly in women with mammographic microcalcifications of an equivocal nature.Rich, P. M. (1999) Clinical Radiology54 , 384–389.

Flow cytometric DNA analysis of excised breast lesions: use of fresh tissue needle aspirates obtained under guidance with mammography of the specimen.

Eighty consecutive biopsy specimens were studied to determine whether DNA analysis could be performed on fine-needle aspirates of excised clinically occult breast lesions obtained under guidance with mammography of the specimen before fixation to offer the advantages of fresh-tissue analysis. With use of single aspirates, cytologic analysis was possible in 50 cases (62%); DNA analysis was possible in 75 cases (94%). These methods combined offered no statistically significant increase in sensitivity for detection of malignancy compared with cytologic analysis alone. Forty-one percent of the analyzable invasive carcinomas showed aneuploidy. Aneuploidy and high S phase fractions of the invasive carcinomas showed no substantial correlation with patient age, nodal status, and size or appearance of the mammographic lesion. Aneuploidy was also seen in zero of four analyzable lesions showing ductal carcinoma in situ, two of 13 showing atypical hyperplasia (15%), and one of the 28 remaining benign lesions (4%). The authors conclude that this mammographic intervention is an effective means of obtaining fresh tissue samples of clinically occult lesions for DNA analysis.