Use Of Core Biopsy Research Articles

Abstract P3-09-19: The utility of using genomic testing on needle core biopsies during the COVID-19 pandemic: Molecular characterization, risk stratification, neoadjuvant outcome, and future implications

Abstract Introduction: The COVID-19 pandemic has caused an extraordinary challenge for global health. New guidelines were implemented, including postponing non-essential surgical procedures to conserve resources. In response, the COVID19 Pandemic Breast Cancer Consortium expert opinion suggested the use of core biopsies for genomic testing to help triage patients for surgical vs. systemic treatment. To better understand how expedited genomic results could impact peri-operative care, we performed a pre-operative quality project to assess testing Mammaprint (MP), a 70-gene risk of recurrence assay, and Blueprint (BP), an 80-gene molecular subtyping assay, on core biopsies. Here we report our experience with MP and BP testing on core biopsies, and the correlation between test results and response to neoadjuvant therapy.Design: From April to December 2020, all core biopsies with a breast carcinoma diagnosis from our clinic (300 patients) were routinely sent for MP and BP testing as part of a rapid result program that was initiated to see whether test results could be obtained in time and whether they would lead to more informed pre-operative treatment decisions. Unstained slides were sent for genomic and receptor testing concurrently. When genomic results differed from IHC/FISH results or suggested a different treatment plan vs. clinical factors alone, we referred to this as “reclassification.” For those patients who completed their neoadjuvant chemotherapy, we grouped them by their genomic results and by their conventional IHC/FISH/Clinical classification, and compared the outcome.Results: MP and BP results from core biopsy were available for 96.6% of patients (n=290/300). The average time from biopsy to test results was 10 days, and the average lab turnaround time was 5 days. Results were available for tumor conference discussions 100% of the time. MP and BP re-classified 84 of 300 patients (28%) from conventional IHC/FISH subtyping, and reclassified 42 of 195 patients (22%) of patients from their risk category based on traditional clinical factors (Table-1). Of the 38 patients with available post-neoadjuvant therapy outcome, 13 patients (34%) achieved pathologic complete response (pCR). 16 patients were classified as Her-2 enriched by IHC/FISH of which 9 (56%) achieved pCR. MP/BP aligned with the IHC/FISH Her-2 enriched classification in 11/16 patients, while 5 patients were reclassified to Luminal B by MP/BP. Of the 11 patients with concordant IHC/FISH and MP/BP results, 8 achieved pCR (73%), while one of the 5 cases reclassified to Luminal B achieved pCR (20%). Of the patients who were classified Luminal by IHC (9 patients), one patient achieved pCR (11%), and of the patients classified luminal (A or B) by MP/BP (12 patients) two achieved pCR (16%). Of the IHC-triple negative patients and genomic basal patients, three patients achieved pCR in each group (23% and 20%, respectively).Conclusion: Performing MP/BP tests on core needle biopsies hold a high success rate. Incorporating test results into peri-operative discussions may result in better-informed decisions about treatment planning and timing of surgery versus systemic therapy. A higher rate of pCR was seen in the MP/BP Her-2 enriched group compared to the IHC/FISH Her-2 enriched group. Although this workflow was designed to triage patients during the COVID pandemic, this approach has great potential beyond the pandemic. Table-1: Reclassification Rate vs. path IHC/FISH or Clinical FactorsIHC/FISH/Clinical ◊ Genomic# of reclassified patients/total patients in the corresponding traditional category% of patientsLuminal A ◊ Luminal B25/16116%Luminal A ◊ Her-21/1610.6%Luminal B ◊ Luminal A35/7249%Luminal B ◊ Basal4/726%Her-2 ◊ Luminal A1/313%Her-2 ◊ Luminal B10/3132%Her-2 ◊ Basal1/313%Triple negative ◊ Luminal A4/3611%Triple negative ◊ Luminal B3/368%Clinical high risk ◊ Genomic low risk21/8425%Clinical low risk ◊ Genomic high risk21/11119% Citation Format: Hani Katerji, Huina Zhang, Xi Wang, Linda Schiffhauer, Ajay Dhakal, Alissa Huston, Carla Falkson, David Hicks, Bradley Turner. The utility of using genomic testing on needle core biopsies during the COVID-19 pandemic: Molecular characterization, risk stratification, neoadjuvant outcome, and future implications [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-09-19.

Full-field digital mammography: Is the apparent increased detection of microcalcification leading to over-investigation and over-diagnosis?

Modern full-field digital mammography (FFDM) appears to have increased the detection of breast microcalcification. This retrospective study aimed to assess whether this is associated with over-investigation and possible over-diagnosis of breast pathology of lesser significance. Three 2-year periods were studied, in which different mammographic technologies were used exclusively viz., classical screen-film mammography (SFM) in 2003-04, computed radiography (CR) in 2009-10 and FFDM in 2012-13. The study was limited to women in whom biopsy was done for indeterminate, suspicious or malignant (ISM) calcification as the only mammographic abnormality. Between the first and the third time periods, the use of core biopsies and vacuum-assisted biopsies (VABs) for 'ISM calcification only' increased from 0. 6% to 1.4% of all mammograms, and biopsies with malignant results increased from 0.18% to 0.33% of all mammograms. VAB became the preferred technique for biopsy over the study period. The proportion of cores and VABs with a malignant result did not change significantly over the three time periods (24-28%), nor did the proportion of invasive cancers, ductal carcinoma insitu (DCIS) (60-63%) or atypia on subsequent excision. The proportion of DCIS which was of high grade was greatest in the FFDM era (69%). Less than 9% of DCIS were of low grade in all three time periods. Despite increased numbers of biopsies being performed, there was no increase in findings of breast pathology of lesser significance. Improved technology (FFDM and VAB) allows immediate biopsy of small clusters of indeterminate microcalcification, rather than using mammographic surveillance, and this study found no evidence that this has been associated with over-investigation or over-diagnosis.

Use of core biopsy in diagnosing cervical lymphadenopathy: a viable alternative to surgical excisional biopsy of lymph nodes?

OBJECTIVES Lymphoma often presents with a neck mass and while fine-needle aspiration cytology may be suggestive, tissue biopsy is required for reliable diagnosis and classification of a lymphoma that is sufficient to deliver the correct treatment for the patient. Traditionally, excisional biopsy of a lymph node has been the standard method of tissue sampling, providing ample tissue for assessment. However, this requires theatre time, and preceding fine-needle aspiration cytology, which may incur a delay. With careful use of tissue, coupled with advances in immunohistochemical and molecular investigative techniques, core biopsy provides a possible alternative to traditional fine-needle aspiration and excisional biopsy. In this study, we aimed to determine the efficacy of diagnosing neck masses. METHOD A retrospective analysis was performed of patients being investigated for a neck mass who were undergoing ultrasound-guided core biopsies of cervical lymph nodes over a 17-month period. The final histology report was scrutinised to assess whether adequate tissue was obtained to allow for full tissue diagnosis. RESULTS Over the 17-month period analysed, 70 patients with cervical lymphadenopathy underwent core biopsy. Of these, 63 (90%) were diagnostic for either lymphoma or other pathology and did not require further tissue sampling. Overall, 19 patients were diagnosed with lymphoma, of which only 1 required further biopsy due to inconclusive initial core biopsy. CONCLUSIONS Current guidelines for investigating lymphomas require that excisional biopsy be performed to obtain ample tissue to allow full nodal architecture assessment and ancillary investigation to reach an accurate histological classification. Within our head and neck multidisciplinary team, however, it is considered that results from core biopsies can be obtained in a more timely fashion and with histological accuracy equal to those of open biopsy. The results obtained demonstrate that core biopsy is an effective tool for investigation. We believe this should be the first-line investigation of choice, as it reduces the need for patients to undergo surgery, is more cost effective and offers a faster diagnosis.

The growing fibroadenoma.

BackgroundFibroadenomas (FAs) are the most common tumors of the breast clinically and pathologically in adolescent and young women but may be discovered at any age. With increasing use of core biopsy rather than excision for diagnosis, it is now commonplace to follow these lesions with imaging.PurposeTo assess the incidence of epithelial abnormalities (atypia, in situ or invasive, ductal or lobular malignancies) in FAs diagnosed by core biopsy and to re-evaluate the management paradigm for any growing FA.Material and MethodsA retrospective review of the senior author’s pathology results over 19 years identified 2062 nodular FAs (biopsied by ultrasound or stereotactic guidance). Eighty-three core biopsied FAs were identified which subsequently enlarged.ResultsTwelve of 2062 of core biopsied nodules demonstrated atypia, in situ, or invasive malignancy (ductal or lobular) within or adjacent to the FA (0.58%). Eighty-three FAs enlarged and underwent either surgical excision (n = 65), repeat core biopsy (n = 9), or imaging follow-up (n = 9). The incidence of atypia, in situ or invasive malignancy was 0/83 (0%). Two enlarging FAs were subsequently surgically diagnosed as benign phyllodes tumors (PT).ConclusionMalignancy in or adjacent to a core biopsied FA is rare. The risk of cancer in a growing FA is even rarer; none were present in our series. FAs with abnormal epithelial abnormalities require excision. Otherwise, FAs without epithelial abnormality diagnosed by core biopsy need no specific follow-up considering the negligible incidence of conversion to malignancy. The breast interventionalist must know how to manage discordant pathology results.

Advances in Head and Neck Ultrasound and Their Clinical Applications

Program Description: Office-based ultrasound of the thyroid and neck is now a standard imaging tool for otolaryngologists, endocrinologists, and surgical clinicians. Training courses in the use of ultrasound are now well-structured and available to clinicians in their related disciplines. Yet, as with all standard technology, new applications and refinements have expanded both the resolution of image quality and uses of ultrasound beyond what was initially envisioned. Through the use of both short didactic presentations and directed questions with clinical case examples from the moderator, this panel of experts will discuss several new frontiers of ultrasound. Techniques that optimize cytologic aspiration, indications and use of core biopsy, alcohol ablation of thyroid cysts, and selection of cases of lymph node ablation with papillary carcinoma, elastography, and the evolving use of radiofrequency ablation and contrast enhanced ultrasound are some of the topics that will be covered. An emphasis on how best to improve the standard use of head and neck ultrasound will make this a practical seminar for the otolaryngologist as well as an important glimpse into the near future. Educational Objectives: 1) The seminar attendee should learn new advances in obtaining cytologic samples with ultrasound. 2) The seminar attendee will understand new advances in destroying malignant lymph nodes and cysts of the thyroid gland including advantages and disadvantages of the technology compared with conventional surgery. 3) The seminar attendee will learn new adjunctive technologies to ultrasound such as elastography and contrast imaging.

What is the added value of combined core biopsy and fine needle aspiration in the diagnostic process of renal tumours?

PurposeNon-diagnostic results still hinder the routine use of core biopsy (CB) and fine needle aspiration (FNA) in the diagnostic process of renal tumours. Furthermore, substantial interobserver variability has been reported. We assessed the added value of combining the results of CB and FNA by five pathologists in the ex vivo diagnosis of renal mass.MethodsTwo ex vivo core biopsies were taken followed by two FNA passes from extirpated tumours. All samples were evaluated by five blinded pathologists. A consensus diagnosis of the surgical specimen was the index for comparison. For each pathologist, the number of non-diagnostic (non-conclusive or undetermined biology and failed biopsies), correct and incorrect scored cases of each technique was assessed. When a non-diagnostic CB or FNA had a correct diagnostic counterpart, this was considered as of added value.ResultsOf the 57 assessed tumours, 53 were malignant. CB was non-diagnostic in 4–10 cases (7–17.5%). FNA established the correct diagnosis in 1–7 of these cases.FNA was non-diagnostic in 2–6 cases (3.5–10.5%), and the counterpart CB established the correct diagnosis in 1–6 of these cases.For the 5 pathologists, accuracy of CB and FNA varied between 82.5–93% and 89.5–96.5%, respectively. Combination of both types of biopsy resulted in 55–57 correct results (accuracy 96.5–100%), i.e., an increase in accuracy of 3.5–14%.ConclusionCombining the result of CB and FNA in renal mass biopsy leads to a higher diagnostic accuracy. Recommendations on which technique used should be adapted to local expertise and logistic possibilities.

Increase of core biopsies in visceral organs–experience at one institution

All targeted core biopsies in the surgical pathology file and all cytology specimens from liver, lung, kidney, and pancreas accessioned in 1997, 2002, and 2007 in the Pathology Department at the Beth Israel Deaconess Medical Center, Boston, were culled. Cytology specimen type [touch imprint smear (TIS) from core-only, fine-needle aspiration (FNA)-only, or both] was determined. Seven hundred and fifty-eight targeted core biopsies were identified from the years 1997 (162), 2002 (249), and 2007 (347). Eight hundred and seventy-eight cytology specimens from the years 1997 (127), 2002 (264), and 2007 (487) were included. The overall percentage of TIS-only of all cytology specimens increased from 5.5 to 31% in 10 years and most prominently in the liver (14% in 1997 to 87% in 2007). In spite of the increasing use of core biopsies, the volume of cytology specimens from these organs increased from 127 in 1997 to 487 in 2007.

Success of Image-guided Biopsy for Small (≤ 3 cm) Focal Liver Lesions in Cirrhotic and Noncirrhotic Individuals

Imaging techniques can detect small liver lesions, although these are a challenge to biopsy, particularly in cirrhotic liver. The authors assessed the diagnostic success of image-guided biopsies collected from small (≤ 3 cm) focal liver lesions. This single-center, retrospective study included 374 patients (199 men; mean age, 62 ± 15). Eighteen-gauge core biopsy and 22-gauge fine needle aspiration (FNA) samples were collected from small focal liver lesions. Samples were compared by histology versus cytology, malignant versus benign, from lesions smaller versus larger than 1.5 cm, from livers with versus without cirrhosis, collected by computed tomography (CT) guidance versus ultrasound, and from different locations in the liver. The combined accuracy of core biopsy plus FNA analysis was 95.5%; core biopsy alone characterized 93.3% of samples, and FNA alone characterized 72.5% (P < .001). Biopsy successfully characterized 94.5% of malignant lesions and 98.8% of benign lesions (P > .05). Biopsy characterized 95.3% (102 of 107) lesions ≤ 1.5 cm. The success in cirrhotic livers was 94.8%, for CT-guided biopsies was 95%, and for ultrasound-guided biopsies was 95.8% (P > .05). The success rate was lower in liver caudate lobe than in other locations (P < .05). Image-guided biopsy of small (≤ 3 cm) focal liver lesions is highly reliable with the use of core biopsy alone. Neither size ≤ 1.5 cm nor presence of cirrhosis is an impediment to biopsy. CT and ultrasound guidance produce similar rates of success.

Carcinoma mucinoso invasor da mama e seus diagnósticos diferenciais em biópsia por agulha grossa: revisão da literatura

A biópsia por agulha grossa (BAG), ou core biopsy, é uma técnica utilizada para retirar pequenos cilindros de tecido mamário. Além de lesões palpáveis, o desenvolvimento de técnicas radiológicas acuradas de localização de lesões mamárias difundiu o uso da BAG como primeira abordagem histológica de lesões não palpáveis. O diagnóstico diferencial do carcinoma mucinoso com lesões mucinosas benignas por BAG pode ser desafiador, principalmente se a lesão apresentar extravasamento de mucina. A acurácia do diagnóstico nesses casos é de extrema relevância para determinar o tipo de procedimento a ser realizado e o tratamento a ser seguido. Este estudo traz revisão e atualização da literatura sobre carcinoma mucinoso invasor da mama e seus diagnósticos diferenciais, com ênfase nos desafios para diagnóstico por intermédio da BAG. Entre os diagnósticos diferenciais estão alterações fibrocísticas com mucina luminal, lesões mucinosas papilares e mucocele-símile (que variam desde as benignas até aquelas associadas a hiperplasia ductal atípica e carcinoma ductal in situ). Alterações mucinosas também podem ser encontradas em uma variedade de lesões, como fibroadenoma e tumor phyllodes, adenoma pleomórfico e mucinose nodular. Conclui-se que a BAG é uma técnica confiável para diagnóstico de carcinoma mucinoso da mama e seus diagnósticos diferenciais, porém, em casos de dúvida ou de escassez de material, é prudente realizar biópsia excisional para melhor esclarecimento do diagnóstico.

Punch biopsy: A useful adjunct in a rapid diagnosis breast clinic

Introduction Triple assessment of breast lesions usually involves the use of core biopsy (CB) or fine needle aspiration cytology (FNAC). Punch Biopsy (PB) is a technique widely used by dermatologists and can be used in superficial breast lesions with dermal involvement. We studied the utilization of PB in a rapid diagnosis breast clinic. Method We reviewed patients who underwent a PB over a seven and a half-year period from December 2001 to May 2009. The indications for biopsy and the contribution of PB to final diagnosis were studied. Results The commonest indications were breast lump with skin involvement or ulceration ( n = 27), suspected Paget's disease ( n = 25), discolouration of breast skin ( n = 23), and nodules in the breast skin or surgical scar ( n = 18). Final diagnosis was benign in 80 patients and malignant in 20. In 74 patients with benign and 7 patients with malignant diagnoses, PB was the only source of histological diagnosis. Conclusion PB is a valuable adjunct to conventional methods of tissue diagnosis such as CB and FNAC in both benign and malignant breast lesions.

PREOPERATIVE CORE BIOPSY OF SOFT TISSUE TUMOURS FACILITATES THEIR SURGICAL MANAGEMENT: A 10-YEAR UPDATE

Soft tissue sarcomas (STS) are rare. More often than not, the possibility of STS is not considered preoperatively and the lesions are enucleated. Enucleation (excisional biopsy) is inappropriate for sarcomas as it compromises the planning of definitive surgery and radiotherapy. Incisional biopsy has been regarded as the biopsy of choice by some, but it has a high rate of wound complications. The aims of the study were (i) to assess the current accuracy of core biopsy in the diagnosis of STS; (ii) to assess whether preoperative core biopsy facilitates the surgical management of soft tissue tumours; and (iii) to evaluate whether there has been an increase in the use of core biopsy before referral. Patients with soft tissue tumours managed by a surgeon with a special interest in soft STS from 1994 to 2007 were reviewed from data collected in a database prospectively. The accuracy of core biopsy in the diagnosis of soft tissue tumours and planning of definitive surgery were assessed. Ninety-four patients with 98 lesions were reviewed. Sixty-eight lesions had core biopsy. The overall sensitivity of core biopsy in diagnosing soft tissue tumours was 83.6%. It has a sensitivity of 91.3% and specificity of 100% for malignant STS. For patients who had core biopsy, 95% had one-stage surgery; those who had no core biopsy, only 45% had one-stage surgery (P value <0.001). Core biopsy is accurate in the diagnosis of soft tissue tumours. It is safe and does not have the complications of open biopsy. It enables most patients to have one-stage surgery.

The role of breast FNAC in diagnosis and clinical management: a survey of current practice

Most participating countries have now adopted a triple assessment approach, i.e. clinical,imaging and pathology, to breast diagnosis, with FNAC as the first-line pathological investigation in both screening and symptomatic populations, with the exception of microcalcifications. Pathologists specialized in cytopathology are best qualified to collect and interpret FNAC samples, but this is not always possible or practical. Radiologists involved in breast imaging should ensure that they have the necessary skills to carry out FNAC under all forms of image guidance. Best results are achieved by a combination of both techniques, as shown in the image-guided FNAC in the presence of the cytopathologist. The majority of European countries use similar reporting systems for breast FNAC (C1-C5), in keeping with European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis, although some still prefer descriptive reporting only. When triple assessment is concordant, final treatment may proceed on the basis of FNAC, without a tissue biopsy. ER and PR assessment can be done safely on FNAC material. However, not all institutions may have expertise in doing this. HER-2 protein expression on direct cytological preparations is insufficiently reliable for clinical use, although its use for FISH is possible, if expertise is available. The majority of participants practise a degree of one-stop diagnosis with a cytopathologist present in the out-patient clinic. Formal recognition of the importance of the time spent outside the laboratory, both for cytopathologist and cytotechnologist, is necessary in order to ensure appropriate resourcing. The use of core biopsy (CB) has increased, although not always for evidence-based reasons. CB and FNAC are not mutually exclusive. FNAC should be used in diagnosis of benign, symptomatic lesions and CB in microcalcifications, suspicious FNAC findings and malignancies where radiology cannot guarantee stromal invasion.

Diagnostic value of CT-guided biopsy of indeterminate renal masses

AIM: To evaluate the role of percutaneous core biopsies in the diagnosis of renal masses that could not be classified as benign or malignant based upon imaging alone. MATERIALS AND METHODS: We retrospectively analysed core biopsies of indeterminate renal masses of 23 patients who were referred to us for computed tomography (CT)-guided biopsy from 1996–2001. Follow-up ranged from 1–5 years. Analysis was based on indications for biopsy, size and characteristics of the lesion and accuracy of biopsy results. RESULTS: There was one technical failure in 22 patients included in the analysis. Fifteen core biopsies revealed malignancies that were confirmed either clinically or surgically. Seven were benign, one of which was false-negative. The sensitivity was 93%, specificity 100%, positive predictive value 100% and negative predictive value 75%. The results in tumours ≤3 cm were similar to those in larger lesions. CONCLUSIONS: We recommend the use of core biopsy as a diagnostic tool for indeterminate renal masses, regardless of mass size. Renal core biopsy can influence the management of lesions: primary renal lesions are resected, while treatment for metastatic disease is tailored to the primary tumour. Tumours with benign biopsy results should be re-evaluated and either referred for resection of the mass or followed up closely with clinical observation and of imaging studies.

Imprint cytology of needle core-biopsy specimens of breast lesion: is it best of both worlds?

The concept and working of one-stop breast clinic has been evolving over the last 10 years. With more frequent use of core biopsy by the dedicated breast units, one-stop results service cannot be provided. The purpose of this study was to examine the feasibility of the use of imprint cytology of the core-biopsy specimens of breast lesions in a one-stop setting, in order to spare patients pain and suffering of a needle test without anaesthetic while retaining the advantages of availability of greater pathological characteristics of tumours by core biopsy. Forty-one consecutive core-biopsy specimens from symptomatic patients who underwent free hand or ultrasound-guided core biopsies of the suspected breast lesion were rolled on a glass slide to obtain imprint cytology. The cytological reporting was done independent of histological reporting of core biopsy. Overall concordance between imprint cytology and histology was 90%. For imprint cytology overall sensitivity was 91% and specificity was 89%. The positive predictive value was 97% and negative predictive value was 73%. Imprint cytology was found to be a quick, reliable and effective way of diagnosing breast lesions in breast clinic.

The use of fine-needle aspiration cytology and core biopsy in the assessment of highly suspicious mammographic microcalcifications: analysis of outcome for 182 lesions detected in the setting of a population-based breast cancer screening program.

Fine-needle aspiration biopsy (FNAB) is used as the first-line diagnostic test for lesions that require morphologic assessment in the authors' breast cancer screening program. A positive cytologic diagnosis is an indication to proceed to definitive surgery. Core biopsy is used if FNAB is not diagnostic. In the context of increased use of core biopsy at other centers, the authors reviewed their experience with the cytologic assessment of highly suspicious microcalcifications. Between January 1996 and June 2000, the dominant radiologic abnormality was classified prospectively as high-grade microcalcifications in 182 lesions. Data were recorded on patient demographics, radiologic features, and the findings of FNAB and core biopsy, if performed. The results of the screening assessment were then compared with the final histologic findings. Overall, 15.6% of all radiologically high-grade lesions were microcalcifications. The mean patient age was 58.76 years. The lesions had a mean size of 38.49 mm (range, 5-200 mm), and 92.31% of high-grade microcalcifications proved to be malignant. Among the cases evaluated by FNAB, a positive cytologic diagnosis of malignancy was made in 70.93% of lesions, without any false-positive diagnoses and obviating the need for diagnostic core biopsy. FNAB had a sensitivity of 77.22% and a positive predictive value (PPV) of 100%. When core biopsy was performed due to the absence of a positive cytologic diagnosis, it averted the need for open biopsy in 76% of lesions. Where there is access to skilled cytopathologists, FNAB can provide a highly accurate, rapid, and cost-effective means of triage of patients who would benefit most from the more expensive core biopsy.

The National Health Service Breast Screening Programme and British Association of Surgical Oncology audit of quality assurance in breast screening 1996-2001.

The National Health Service Breast Screening Programme (NHSBSP) is an example of a nationally coordinated quality assurance programme in which all the professional groups involved participate. Surgeons, radiologists and pathologists defined the clinical outcome measures against which they would subsequently be audited. The NHSBSP and the Association of Breast Surgery at BASO are jointly responsible for coordinating an annual audit of all surgical activities undertaken within the NHSBSP. The trends for key outcome measures between 1996 and 2001 are provided. The preoperative diagnosis rate (minimum standard 70 per cent or more) improved from 63 to 87 per cent. This rise was mirrored by an increase in the use of core biopsy in preference to fine-needle cytology. The proportion of patients in whom lymph node status was recorded improved from 81 to 93 per cent. There was no significant change in the number of women treated by low case-load surgeons and waiting times for surgery increased through the study interval. The BASO-NHSBSP Breast Audit has recorded major changes in clinical practice over 5 years. A key feature has been the dissemination of good practice through feedback of the results at local and national level.

Changes in Diagnostic Methods of Non-palpable Breast Lesions: Analysis for 5 Years

Purpose: To describe the changes in diagnostic methods and reassess the role of core biopsy compared with needle localization biopsy (NLB) in the evaluation of non-palpable breast lesions. Materials and Methods: We retrospectively analyzed 930 non-palpable breast lesions which underwent either core biopsy or NLB between January 1996 and December 2000. NLB involved 511 lesions in 482 patients, and core biopsy, 419 lesions in 365 patients. For a given lesion, NLB was guided by either mammography (n=213) or ultrasonography (US) (n=298), but only US was used to guide a core biopsy. Over the five-year period, we calculated the total number of biopsies per year relating to non-palpable breast lesions, also determining the mammographic findings in cases involving NLB and the percentage of malignancies seen at histopathology. Results: The total number of biopsies increased with time: 1996: n=91, 1997: n=118, 1998: n=144, 1999: n=245, 2000: n=332. The implementation of core biopsy, however, led to a decrease in the proportion of NLB (1996: 97.8%, 1997: 84.7%, 1998: 75.7%, 1999: 47.8%, 2000: 28.9%). Among nonpalpable lesions which underwent mammography-guided NLB, 46.5% (20/43) were a mass or density in 1996, while in 2000 the proportion was 5.7% (2/35). During this period, however, the finding of calcification without a mass increased from 48.8% in 1996 to 94.3% in 2000. The proportion of cases in which NLB demonstrated malignancy increased from 13.5% in 1996 to 49% in 2000; where US-guided NLB was used, the increase was remarkable: from 15.2% in 1996 to 65.6% in 2000. Conclusion: In the evaluation of non-palpable breast lesions, the appropriate use of core biopsy can decrease the need for a more invasive method such as NLB. Furthermore, because most benign lesions diagnosed by core biopsy do not also undergo NLB, the use of the latter increases the yield of malignancies.

Conversion to core biopsy in preoperative diagnosis of breast lesions: is it justified by results?

In recent years there has been increased use of core biopsy for the preoperative diagnosis of screen detected and symptomatic breast lesions. The aim of this study was to compare the quality assessment parameters for preoperative diagnosis by fine needle aspiration cytology (FNAC) before conversion to core biopsy with those for core biopsy after conversion in screening and symptomatic practice. Accuracy of typing and grading of tumours on core biopsy was assessed. Correlation of FNAC (C1-5) and core biopsy (B1-5) results (total of 1768 cases) with subsequent available resection histology was performed for 473 FNAC samples in 1997/98, 349 core biopsies in 1998/99 performed in symptomatic practice, for 561 FNAC samples in 1997/98, and 385 core biopsies in 1998/99 performed in screening. Quality assessment parameters were calculated using the methodology detailed in the National Health Service Breast Screening Programme guidelines for cytology practice. Increased absolute and complete specificity, lower inadequate rates, and lower suspicious rates were found for core biopsy compared with FNAC in both symptomatic and screening practice. Typing of tumours was attempted in 86.7% of core biopsies in symptomatic practice and was accurate in 93.6% (132 of 141 where type was stated). Grading of tumours was attempted in 63.5% of invasive carcinomas, with the provisional grade on core biopsy being confirmed on later histology in 75% of grade 1 cases, in 70% of grade 2 cases, and in 86% of grade 3 cases. No case provisionally graded as 1 was subsequently found to be grade 3 and no provisionally grade 3 case was found to be grade 1. Conversion to core biopsy for the preoperative diagnosis of breast lesions increases specificity and reduces inadequate and suspicious rates. Grading and typing of tumours and assessment of oestrogen receptor status by immunocytochemistry is also possible in core biopsy, thereby increasing diagnostic information available when considering treatment options.

Changing trends in breast fine-needle aspiration: Results of the Papanicolaou society of cytopathology survey

Following the NCI-sponsored consensus conference on fine-needle aspiration of the breast, the Criteria and Nomenclature Task Force of the Papanicolaou Society of Cytopathology undertook a survey to assess the status of these issues and recommendations among practicing cytopathologists. The survey was designed to assess the impact of the changing trends in the diagnosis of breast lesions on cytopathology laboratories. It also intended to assess the impact of the recommendations of the consensus conference concerning the inclusion of a statement in breast FNA reports recommending the use of the triple test, the use of the proposed diagnostic terminology, and to evaluate criteria for specimen adequacy in breast FNAs used in different institutions. The results of this survey indicate the impact of an increasing use of core biopsies on the number of breast FNAs performed over the last several years. The recently recommended diagnostic terminology for breast FNA has quickly gained wide acceptance, as has the fundamental concept of the triple test. The issue of specimen adequacy, however, remains controversial, with some laboratories utilizing quantitative criteria, while the majority do not. Diagn. Cytopathol. 2000;22:126–130. © 2000 Wiley-Liss, Inc.

Changing trends in breast fine-needle aspiration: results of the Papanicolaou Society of Cytopathology Survey.

Following the NCI-sponsored consensus conference on fine-needle aspiration of the breast, the Criteria and Nomenclature Task Force of the Papanicolaou Society of Cytopathology undertook a survey to assess the status of these issues and recommendations among practicing cytopathologists. The survey was designed to assess the impact of the changing trends in the diagnosis of breast lesions on cytopathology laboratories. It also intended to assess the impact of the recommendations of the consensus conference concerning the inclusion of a statement in breast FNA reports recommending the use of the triple test, the use of the proposed diagnostic terminology, and to evaluate criteria for specimen adequacy in breast FNAs used in different institutions. The results of this survey indicate the impact of an increasing use of core biopsies on the number of breast FNAs performed over the last several years. The recently recommended diagnostic terminology for breast FNA has quickly gained wide acceptance, as has the fundamental concept of the triple test. The issue of specimen adequacy, however, remains controversial, with some laboratories utilizing quantitative criteria, while the majority do not. Diagn. Cytopathol. 2000;22:126-130.