Evaluation of inadequate, indeterminate, false-negative and false-positive cases in cytological examination for breast cancer according to histological type

e22085 Background: Breast cancer is one of the most common cancer in women. Early detection, early diagnosis and early treatment play key role in fighting against breast cancer. OPTIMUS system is a system of diffused optical tomography with ultrasound. It provides dual modality images for early diagnosis of breast cancer. The aim of this study was to evaluate the OPTIMUS system on diagnosis of breast disease. Methods: OPTIMUS system was applied to 160 breast tumor patients. All patients had received surgical treatment and had definite pathological diagnosis. OPTIMUS system was evaluated as diagnostic tool of breast tumor in this study. Results: There were 42 cases diagnosed as benign breast disease and 118 cases diagnosed as breast cancer by OPTIMUS system. Pathology confirmed 60 cases of benign disease and 100 cases of breast cancer. False positive rate of breast cancer was 30% (18/60). False negative rate of breast cancer was 0% (0/100). The pathology of false positive cases was mild and severe papillomatosis (6/18), non-typical hyperplasia (4/18), chronic inflammation (3/18), fibroadenoma (3/18) and fat necrosis (2/18). Papillomatosis and non-typical hyperplasia are precancerous lesions and often difficult for clinical diagnosis. In this study the false positive diagnostic rate of mammography and ultrasonography is 13% and 11.1% respectively. Conclusions: OPTIMUS system is a non- invasive and highly effective diagnostic tool for breast disease. Its sensitivity is reached to 100% and specificity is about 70% on the diagnosis of breast cancer. OPTIMUS system could be used as assistant diagnostic tool for breast tumor. No significant financial relationships to disclose.

Download Full-text

The Lifetime Economic Burden of Inaccurate HER2 Testing: Estimating the Costs of False-Positive and False-Negative HER2 Test Results in US Patients with Early-Stage Breast Cancer

Value in Health ◽

10.1016/j.jval.2015.01.012 ◽

2015 ◽

Vol 18 (4) ◽

pp. 541-546 ◽

Cited By ~ 13

Author(s):

Louis P. Garrison ◽

Joseph B. Babigumira ◽

Anthony Masaquel ◽

Bruce C.M. Wang ◽

Deepa Lalla ◽

...

Keyword(s):

Breast Cancer ◽

Economic Burden ◽

False Positive ◽

Early Stage ◽

False Negative ◽

Early Stage Breast Cancer ◽

Test Results ◽

Her2 Testing

Download Full-text

Is there a role of frozen section of sentinel lymph node in patients with early breast cancer for the management of axilla in India: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20192379 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2126

Author(s):

Anshika Arora ◽

Neena Chauhan ◽

Sunil Saini ◽

Nishish Vishwakarma ◽

Tanvi Luthra

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Early Breast Cancer ◽

False Positive ◽

Frozen Section ◽

False Negative ◽

Lymph Node Biopsy ◽

True Negative ◽

Node Negative

Background: Evaluation of axilla using sentinel lymph node biopsy (SLNB) is the standard of care in node negative early breast cancer. Intra operative assessment of SLNB with frozen section (FS) often guides the surgeon regarding decision for level of axillary dissection. The aim of this study was to evaluate accuracy of FS of SLNB in these patients with histopathology examination (HPE) as the gold standard.Methods: This study was performed between July 2017 and November 2018. After gross evaluation of SLNB, nodes were cut in half and frozen; the other half was preserved for HPE. For FS, nodes were sectioned to 4 mm width and examined.Results: A total of 61 patients underwent SLNB, 55 patients undergoing intra-operative FS. The mean age was 53 years (range 30-84, ± 15.09 SD), primary tumor was clinically T1 in 23.6%, T2 in 76.4% patients. A median of four sentinel nodes were identified, mean size 13.84 mm. On FS SLNB was positive for metastasis in 14 (25.5%), on HPE in 16 (29.1%) patients. There were 13 true positive, 38 true negative, 3 false negative and 1 false positive result for FS. The sensitivity, specificity, positive and negative predictive value, false negative and false positive rates were 81.25%, 97.44%, 92.86%, 92.73%, 18.75% and 2.56% respectively in this study. The overall accuracy of FS of SLNB in early carcinoma breast was found to be 92.73%.Conclusions: An intra-operative FS of the SLN in node negative early breast cancer is a highly sensitive tool in axilla management.

Download Full-text

Selective Use of Intraoperative Touch Prep Analysis of Sentinel Nodes in Breast Cancer

The American Surgeon ◽

10.1177/000313480507101110 ◽

2005 ◽

Vol 71 (11) ◽

pp. 955-962 ◽

Cited By ~ 1

Author(s):

Rachel C. Forbes ◽

Clovis Pitchford ◽

Jean F. Simpson ◽

Glen C. Balch ◽

Mark C. Kelley

Keyword(s):

Breast Cancer ◽

Predictive Value ◽

False Positive ◽

False Negative ◽

Nodal Metastasis ◽

Axillary Lymph ◽

Sentinel Nodes ◽

Number Of Patients ◽

The Impact ◽

Positive Results

Imprint cytology (touch prep) is often used for intraoperative examination of sentinel nodes in breast cancer. This allows axillary lymph node dissection (ALND) to be performed immediately for tumor-positive nodes. We evaluated the accuracy of touch prep examination of sentinel nodes and its role in the surgical treatment of breast cancer. We analyzed 169 breast cancer patients who underwent 170 lymphatic mapping procedures with intraoperative touch prep examination. Results from the touch prep were correlated with histopathology and clinical variables. There were 115 true-negative, 35 true-positive, 15 false-negative, and 5 false-positive results. Touch prep had a sensitivity of 70 per cent and specificity of 96 per cent. Positive predictive value, negative predictive value, and diagnostic accuracy were all 88 per cent. The false-negative rate was 30 per cent and correlated with the size of the nodal metastasis and number of involved nodes, but not other patient factors. Touch prep is useful for the evaluation of sentinel nodes in breast cancer, but it has a lower sensitivity than initially reported, particularly in patients with micrometastases. False positive results occur, although they may be reduced after experience with the technique. We recommend that suspicious findings on touch prep should be confirmed by frozen section and that ALND only be performed for histologically documented metastases. We currently perform touch prep only in patients who are at high risk of nodal metastasis or will undergo mastectomy. This improves operative efficiency and limits the impact of false positive and negative results without dramatically increasing the number of patients who require a second surgical procedure.

Download Full-text

MRI in the Early Detection of Breast Cancer in Women with High Genetic Risk

Tumori Journal ◽

10.1177/030089160609200609 ◽

2006 ◽

Vol 92 (6) ◽

pp. 517-523 ◽

Cited By ~ 33

Author(s):

Giovanna Trecate ◽

Daniele Vergnaghi ◽

Siranuosh Manoukian ◽

Silvana Bergonzi ◽

Gianfranco Scaperrotta ◽

...

Keyword(s):

Breast Cancer ◽

Early Detection ◽

False Positive ◽

Genetic Risk ◽

Brca2 Mutation ◽

False Negative ◽

Conventional Imaging ◽

High Genetic Risk ◽

Second Look ◽

Positive Results

Aims and background Women with BRCA1 or BRCA2 germline mutations have an elevated risk of developing breast and/or ovarian cancer. Because of the early onset of the disease, screening of this group of women should start at an earlier age than in the general population. The association of breast magnetic resonance imaging (BMRI) and ultrasonography (US) with mammography (MX) and clinical breast examination (CBE) in the regular surveillance of these individuals has been proposed and seems to improve the early detection of breast cancer. Methods Within a multicenter study started by the Istituto Superiore di Sanita (Rome), at the Istituto Nazionale Tumori of Milan (INT) we enrolled 116 women at high genetic risk for breast cancer; they were either BRCA1 or BRCA2 mutation carriers or had a strong family history of breast cancer. They underwent CBE, MX, US and BMRI once a year. Results Between June 2000 and April 2005, at INT 12 cancers were detected among the 116 screened individuals (10%). In this subgroup, 1 patient refused BMRI and in 2 cases US was not performed. With BMRI we found 11 cancers and 6 of them were detectable only by this technique. In these 6 cases, the size of the disease was less than 1 cm and MX was false negative due to irregularly nodular parenchyma in 4 cases and scar tissue or prosthesis in the other 2. US was not performed in 2 cases and was false negative in 4 cases. Three false positive results were found with BMRI: 1 case was considered suspect but related to hormonal influences; 1 case with the same pattern was sent for second-look US, which gave a negative result and BMRI review after 6 months showed normalization of the parenchyma; in the third case histology revealed the presence of adenosis. No false positive results were registered for MX. Conclusions The aim of secondary prevention is the detection of cancer at its earliest stage. BMRI screening in women with BRCA1 or BRCA2 mutations or at high familiar risk appears to be highly sensitive and may detect mammographically occult disease. The accuracy of MR imaging is higher than that of conventional imaging but the technique is flawed by a lower specificity. In order to avoid unnecessary biopsies we believe that the combination of BMRI and conventional imaging can be very useful in screening women with a high genetic risk of breast cancer, especially with second-look evaluation by means of US when BMRI yields the only positive diagnostic result. Second-look US has been demonstrated to be of critical importance both in recognizing false positive BMRI results and in guiding biopsies, when necessary.

Download Full-text

Analysis of the causes of false negative and false positive results of preoperative axillary ultrasound in patients with early breast cancer – a single-centre study

Współczesna Onkologia ◽

10.5114/wo.2018.82644 ◽

2018 ◽

Vol 22 (4) ◽

pp. 247-251 ◽

Cited By ~ 1

Author(s):

Tomasz Nowikiewicz ◽

Adam Nowak ◽

Magdalena Wiśniewska ◽

Michał Wiśniewski ◽

Magdalena Nowikiewicz ◽

...

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

False Positive ◽

False Negative ◽

Axillary Ultrasound ◽

Single Centre ◽

Centre Study ◽

Single Centre Study ◽

Positive Results

Download Full-text

Complex radiologic imaging of early breast cancer (literature review)

Modern Oncology ◽

10.26442/18151434.2019.3.190469 ◽

2019 ◽

Vol 21 (3) ◽

pp. 26-32

Author(s):

Giunel S Aliyeva ◽

Galina P Korzhenkova ◽

Irina V Kolyadina

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

False Positive ◽

Breast Biopsy ◽

Hormone Replacement ◽

False Negative ◽

Treatment Algorithm ◽

Significant Proportion ◽

Negative Results ◽

False Negative Results

Clinicoroentgenological diagnosis of early breast cancer - BC (non-invasive or invasive small-sized cancers) is difficult due to the absence of any characteristic clinical symptoms and pathognomonic roentgenological signs of the malignant process. Screening of BC has shown to be one of the most successful projects for early diagnosis of malignancies, but the probability to receive false negative results using screening mammography reaches 12%, and, on the one hand, this is due to interval cancers, and on the other hand - to defects in the primary screening. Among the factors associated with the likelihood of ineffective screening of BC, the most authors highlight such as high breast density, preceding the breast biopsy for a benign process, young age, as well as the use of hormone replacement therapy. The main methods of instrumental BC diagnostics are mammography, ultrasound (US), magnetic resonance imaging (MRI) and positron emission tomography (PET). Mammography is the "gold standard" for both screening and best diagnostics, but is characterized by a high proportion of both false positive and false negative results, and this can be partially solved by the use of digital mammography with tomosynthesis (performing a series of mammography images obtained at different angles and producing the focused 3-D images). Contrast enhanced mammography allows to identify angiogenesis in the area of the predicted malignancy, but is characterized by a high radiation exposure. Breast ultrasound is characterized by low specificity of the method and the high dependence of the result of data interpretation depending on physician qualifications. MRI of the breast for screening is characterized by high sensitivity, but also high cost and high proportion of false positive results. The role of PET/computer tomography in the diagnosis of early BC remains unclear, and the informative value of research in patients with nonpalpable tumors is extremely low. The roentgenological picture of early BC is widely variable; characteristic features include the presence of clustered calcifications, lumps with jagged edges, rough multinodular lumps. However, in a significant proportion of women the only manifestation of early BC is the presence of microcalcinates. Careful analysis of the localization and the shape of microcalcinates and basic characteristics allows correctly interpret the roentgenological diagnosis and helps to choose the optimal diagnostic and treatment algorithm.

Download Full-text

Diagnostic performance of [18F]FDG PET in staging grade 1-2, estrogen receptor positive breast cancer

10.21203/rs.3.rs-695998/v1 ◽

2021 ◽

Author(s):

Ramsha Iqbal ◽

Lemonitsa H Mammatas ◽

Tuba Aras ◽

Wouter V Vogel ◽

Tim van de Brug ◽

...

Keyword(s):

Breast Cancer ◽

Estrogen Receptor ◽

False Positive ◽

Fdg Pet ◽

Imaging Modality ◽

False Negative ◽

True Positive ◽

Histological Subtype ◽

Standardized Uptake Values ◽

Estrogen Receptor Positive

Abstract BackgroundAccurate staging of early breast cancer (BC) patients is essential for tailored treatment. Currently, the preferred imaging modality for staging is positron emission tomography with [18F]Fluorodeoxyglucose (FDG PET) combined with a diagnostic computed tomography (CT) scan of the thorax/abdomen. However, FDG PET might be insufficient for detection of malignant lesions in grade 1–2, estrogen receptor positive (ER+) BC, due to its low metabolic activity. The main aim of this study was to retrospectively investigate the diagnostic accuracy of FDG PET in this patient population.Methods74 patients diagnosed with grade 1–2, ER + clinical stage IIB/III or locoregional recurrent BC were included. Suspect tumor lesions detected on conventional imaging (mammography, ultrasound, magnetic resonance imaging, diagnostic CT, bone scintigraphy) and FDG PET were confirmed with pathology or follow-up. FDG PET-positive lesions were (semi)quantified with standardized uptake values (SUV) and total lesion glycolysis (TLG), and these FDG PET parameters were correlated with pathological features such as histological subtype, grade, ER, PR and HER2 expression and mitotic activity index.ResultsPre-operative imaging identified 155 lesions that were pathologically verified. Based on pathology, 115/155 (74.2%) lesions identified on FDG PET were classified as true positive, i.e. malignant (in 67 patients) and 17/155 (10.8%) lesions as false positive, i.e. benign (in 9 patients); 7/155 (4.5%) as false negative (in 7 patients) and 16/155 (10.3%) as true negative (in 14 patients). FDG PET incorrectly staged 16/70 (22.9%) patients: 3/70 (4.3%) were downstaged whereas 13/70 (18.6%) were upstaged. SUV did not help to discriminate between true- and false positive lesions (median SUVmax 4.23, IQR: 2.54–6.37 vs. 3.07, IQR: 2.14–5.58, P = 0.44 respectively). For true positive lesions, FDG uptake correlated with histological subtype, showing higher uptake in ductal carcinoma compared to lobular carcinoma (P < 0.05).ConclusionWithin this study FDG PET inadequately staged 22.9% of grade 1–2, ER + BC cases. Incorrect staging can lead to inappropriate treatment choices, potentially affecting survival and quality of life. Prospective studies investigating novel radiotracers are urgently needed.Trial registrationretrospectively registered.

Download Full-text