scholarly journals Ultrasound-Guided Core Needle Biopsies of Breast Invasive Carcinoma: When One Core is Sufficient for Pathologic Diagnosis and Assessment of Hormone Receptor and HER2 Status

Diagnostics ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. 54
Author(s):  
Hsin-Ni Li ◽  
Chuan-Han Chen
Keyword(s):  
Hormone Receptor ◽  
Invasive Carcinoma ◽  
Standard Procedure ◽  
Her2 Status ◽  
Breast Carcinomas ◽  
Single Institution ◽  
Core Needle ◽  
Pathologic Evaluation ◽  
Reliable Assessment ◽  
Invasive Carcinomas

Ultrasound (US)-guided core needle biopsy is considered the gold standard procedure with regard to preoperative diagnosis of breast carcinomas. However, there is no clear standard for the number of cores considered to be sufficient for pathologic evaluation, including the expression of surface hormone markers and HER2 status. Images and pathologic slides demonstrating breast invasive carcinoma from a single institution were thus retrospectively reviewed over a 12 month period. The results indicated that one core is sufficient for the diagnosis of invasive carcinomas, along with a reliable assessment of hormone receptor and HER2 status in many cases. The option of applying additional cores is recommended for some cases.

Minimal (≤0.1 cm) Invasive Carcinoma in Breast Core Needle Biopsies

2004 ◽  
Vol 128 (9) ◽  
pp. 996-999
Author(s):  
Andrew A. Renshaw
Keyword(s):  
Minimally Invasive ◽  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Core Needle ◽  
Ductal Hyperplasia ◽  
Ductal Carcinomas ◽  
Invasive Carcinomas

Abstract Context.—Although minimally invasive (microinvasive) carcinoma (≤0.1 cm) of the breast is a well-known and well-characterized entity in excision specimens, the significance of small foci of invasion in breast core needle biopsies has not been well described. Objective.—To define the significance of minimally invasive carcinoma in breast core needle biopsies. Design.—Review of a large series of core needle biopsies for invasive carcinomas measuring 0.1 cm or less and correlation of the results with those of subsequent excision. Setting.—Large community hospital. Results.—From approximately 8500 biopsies, a total of 18 cases of minimally invasive carcinoma from 16 women aged 42 to 80 years were identified. All were present on only 1 of 8 slides made from the block. Overall, the incidence was approximately 0.1% of all biopsies and 1% of all invasive carcinomas. Six cases were invasive lobular carcinomas, 1 was tubulolobular carcinoma, 3 were tubular carcinomas, and the remaining 8 were ductal carcinomas. Eight cases were associated with high-grade comedo ductal carcinomas, 2 with low-grade ductal carcinoma in situ, 3 with atypical ductal hyperplasia, 3 with atypical ductal hyperplasia and lobular carcinoma in situ, and 2 with no other lesion. From a total of 8 sections done entirely through the block, the lesion was present on the first level in 4 cases and the fifth level in 5 cases. No cases were identified in the last 3 levels. Subsequent pathology was available for 16 of the 18 cases. Invasive carcinomas measuring more than 1 cm were present in 9 cases (64%; along with 2 positive lymph nodes), invasive carcinomas less than 1 cm in 2 cases (14%), ductal carcinoma alone in 4 cases (29%), and no carcinoma in 1 case (7%). No pathologic or radiologic features were associated with the finding of invasive carcinoma at excision. Conclusion.—Invasive carcinoma measuring 0.1 cm or less is a rare finding in breast core needle biopsies, is commonly associated with in situ carcinomas and atypical hyperplasias, and is often associated with larger invasive foci at excision. However, invasive carcinomas smaller than 0.1 cm can occur without any other significant findings and may require relatively extensive sampling to identify.

Stereotaxic core needle aspiration biopsy with multiple passes in nonpalpable breast lesions

1998 ◽  
Vol 39 (4) ◽  
pp. 389-394 ◽  
Author(s):  
A. Vega Bolivar ◽  
E. Ortega García ◽  
F. Garijo Ayensa
Keyword(s):  
Core Biopsy ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Breast Lesions ◽  
Breast Carcinomas ◽  
Core Needle ◽  
Invasive Carcinomas ◽  
Noninvasive Carcinoma ◽  
Nonpalpable Breast Lesions

Objective: To compare the grade of histologic agreement between stereotaxic core needle aspiration biopsy (SCNAB) with multiple passes, and surgical excision. Methods: A total of 180 patients with 182 nonpalpable breast lesions underwent SCNAB with multiple passes in an upright add-on stereotaxic device using a manual 1.8-mm needle (15 G). In this group, 125 patients underwent subsequent surgical excision. Results: A SCNAB result indicative of malignancy (invasive or noninvasive carcinoma) was obtained in 68 (87%) of the 78 breast carcinomas (14 noninvasive and 64 invasive) and definitive surgical therapy with a one-stage procedure was performed. Complete or partial agreement between core biopsy and surgery was observed in 19 (86%) of 22 invasive or noninvasive carcinomas discovered by microcalcifications, 40 (97.5%) of 41 invasive carcinomas discovered by a mass, and 9 (60%) of 15 invasive or noninvasive carcinomas discovered by architectural distortion. Six (33%) of the 18 patients whose core biopsies showed noninvasive carcinoma had an invasive or microinvasive component at subsequent surgery. Atypical hyperplasia or benign core biopsy was observed in 6 (8%) and 4 (5%) breast carcinomas respectively. Conclusion: SCNAB with multiple passes is a reliable method for identifying nonpalpable lesions in patients with noninvasive or invasive carcinomas discovered by respectively microcalcifications or mass.

Perspectives on Margins in DCIS: Pathology

2010 ◽  
Vol 8 (10) ◽  
pp. 1219-1222 ◽  
Author(s):  
Susan Lester
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Residual Disease ◽  
Breast Carcinomas ◽  
Margin Involvement ◽  
Pathologic Evaluation

All breast carcinomas must originate within the ductal/lobular system as carcinoma in situ, but only a subset of these lesions progress to invasive carcinoma. Although pathologic evaluation of the extent of ductal carcinoma in situ (DCIS), the distance to margins, and the degree of margin involvement provides an estimation of the likelihood of residual disease, the amount of disease in the remaining breast cannot be predicted with certainty. Factors other than residual disease may be more important in determining whether patients with DCIS survive or succumb to breast cancer, including biologically new ipsilateral cancers, contralateral cancers, and the degree of resistance of the normal stroma to invasion.

Clinicopathological Follow-up of Breast DCIS Diagnosed on Biopsies: A Single Institutional Study of 575 Patients

2021 ◽  
pp. 106689692110120
Author(s):  
Mingfei Yan ◽  
Phillip Bomeisl ◽  
Hannah Gilmore ◽  
Aparna Harbhajanka
Keyword(s):  
Lymph Node ◽  
Axillary Lymph Node ◽  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Univariate Analysis ◽  
Her2 Status ◽  
Axillary Lymph ◽  
Her2 Amplification ◽  
Therapeutic Implications ◽  
Microinvasive Carcinoma

Stratifying ductal carcinoma in situ (DCIS) patients into different upgrading risk groups is important in exploiting more precise therapeutic options. Evaluation of estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 (ER/PR/HER2) status and axillary lymph node metastatic status for DCIS and their upgraded invasive counterparts can also provide diagnostic and therapeutic implications. We retrospectively studied 575 patients with first-time diagnosis of DCIS on biopsies, and followed up their final diagnosis, ER/PR/HER2 status, and axillary lymph node involvement on excisions. As a result, biopsy-diagnosed DCIS had an overall 19.1% risk to be upgraded on subsequent excisions, with 4.7% being upgraded to microinvasive carcinoma (pT1mi) and 14.4% to overt invasive carcinoma (⩾pT1a). Factors significantly associated with higher upgrading risk on multivariate analysis include biopsy guidance by ultrasound ( P <.001), DCIS with suspicious microinvasion ( P < .001), and DCIS diagnosed in left breast ( P = .026). DCIS diagnosed in younger patients (⩽40 years old) or DCIS with high nuclear grade showed higher upgrading risk only on univariate analysis. About 80% ER + /PR + and ER−/PR− DCIS remained the same ER/PR status after being upgraded, and ER + /PR −  DCIS had the highest risk (63.6%) of having HER2 amplification in upgraded invasive carcinoma. For upgraded DCIS, microinvasive carcinoma was more likely to have HER2 amplification (50%) than overt invasive carcinoma (29.5%). Besides, pure DCIS had a low risk of axillary lymph node macrometastasis (0.74%), while the risk increased in DCIS with microinvasion (4.4%) and was highest in overt invasive carcinoma (14.7%). The findings of this study are clinically relevant with respect to criteria that might be used in selecting patients for de-escalation trials.

Survival outcomes in patients with IDC and ILC breast cancer: A well matched single institution study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13056-e13056
Author(s):  
Michael Grimm ◽  
Bhuvaneswari Ramaswamy ◽  
Maryam B. Lustberg ◽  
Robert Wesolowski ◽  
Sagar D. Sardesai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Metastatic Breast ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Her2 Status ◽  
Single Institution ◽  
First Line ◽  
Response To Chemotherapy ◽  
Significant Difference

e13056 Background: Invasive lobular carcinoma (ILC) accounts for only 10-15% of all invasive breast cancers but has distinct clinicopathologic characteristics and genomic profiles. In particular, metastatic lobular cancers (mILC) have unique sites of metastasis and it is unclear if the response to initial endocrine therapy differs from metastatic ductal cancers (mIDC). Therefore we have undertaken a single-institution, retrospective analysis to compare overall outcomes and response to initial endocrine therapy (ET) in patients (pts) with metastatic ILC and IDC. Methods: An IRB approved retrospective review of medical records was conducted evaluating pts treated for metastatic IDC and ILC at The Ohio State University Comprehensive Cancer Center from January 1, 2004 to December 31, 2014. Pts diagnosed with mIDC were matched on age, year of diagnosis, estrogen receptor/progesterone receptor and HER2 status and site of metastasis 2:1 to patients diagnosed with mILC. Overall survival (OS) was defined as the time from metastasis to death or last known follow-up. Progression-free survival (PFS) was defined as time from metastasis to progression on first-line ET. Time to chemotherapy (TTC) was defined as time from starting ET for metastasis to initiation of chemotherapy. Kaplan Meier (KM) methods were used to calculate median OS, PFS and TTC. Results: A total of one hundred sixty one pts with metastatic breast cancer were included in this analysis. The demographic features between the two groups were well balanced and included in the table below. The median OS was 2.6 yrs (95% CI: 1.55, 3.22) for mILC and 2.2 yrs (95% CI: 1.95, 2.62) for mIDC. A subset of 111 patients who started on endocrine therapy were used in the PFS and TTC analyses. The median PFS following first-line ET was 2.2 yrs (95% CI: 0.1.0, 2.7) for mILC and 1.4 yrs (95% CI: 0.91, 1.90) for mIDC. Median TTC was 2.1 yrs (95% CI: 1.71, 4.92) for mILC and 2.4 yrs (95% CI: 1.90, 4.77) for mIDC. There was no statistically significant difference in outcomes between the two groups. Conclusions: Outcomes in patients with ILC and IDC have been varied, with several studies reporting that patients with ILC have worse outcomes and response to chemotherapy. Our retrospective study examining outcomes in mILC in comparison with mIDC showed no difference in OS. Given the concern of resistance to conventional therapies in patients with lobular cancers, it is reassuring to see that the median PFS on first line ET and TTC was similar to metastatic ductal cancers.[Table: see text]

scholarly journals Detection of HER2 Amplification in Breast Carcinomas: Comparison of Multiplex Ligation-Dependent Probe Amplification (MLPA) and Fluorescence In Situ Hybridization (FISH) combined with Automated Spot Counting

2006 ◽  
Vol 28 (4) ◽  
pp. 151-159
Author(s):  
Elna Moerland ◽  
Rens L. H. P. M. van Hezik ◽  
Toine C. J. M. van der Aa ◽  
Mike W. P. M. van Beek ◽  
Adriaan J. C. van den Brule
Keyword(s):  
In Situ Hybridization ◽  
Fluorescence In Situ Hybridization ◽  
Gene Amplification ◽  
Her2 Status ◽  
Her2 Amplification ◽  
Breast Carcinomas ◽  
Her2 Gene ◽  
Her2 Gene Amplification ◽  
Dependent Probe

In this study the detection of HER2 gene amplification was evaluated using Fluorescence In Situ Hybridization (FISH; PathVysion) in comparison with Multiplex Ligation-dependent Probe Amplification (MLPA), a PCR based technique. These two methods were evaluated on a series of 46 formalin fixed paraffin embedded breast carcinomas, previously tested for protein overexpression by HercepTest (grouped into Hercep 1+, 2+ and 3+). HER2 gene amplification (ratio ≥ 2.0) by FISH was found in 9/10, 10/30 and 0/6 in IHC 3+, 2+ and 1+/0 cases, respectively. Digitalized automated spot counting performed with recently developed CW4000 CytoFISH software was 100% concordant with manual FISH scoring. Using MLPA 18/46 samples showed a clear HER2 amplification. Comparing MLPA and IHC showed the same results as for FISH and IHC. All but one FISH positive cases (18/19) were confirmed by MLPA for the presence of the gene amplification. The overall concordance of detection of Her2 gene amplification by FISH and MLPA was 98% (45/46). Furthermore, both the level of amplification and equivocal results correlated well between both methods. In conclusion, MLPA is a reliable and reproducible technique and can be used as an either alternative or additional test to determine HER2 status in breast carcinomas.

scholarly journals Concordance Between ER, PR, HER2 neu Receptors Before and After Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Heba F. Taha ◽  
Ola M. Elfarargy ◽  
Reham A. Salem ◽  
Doaa Mandour ◽  
Amira A. Salem ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Hormone Receptor ◽  
Growth Hormone Receptor ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Her2 Status ◽  
Breast Cancer Patients ◽  
Before And After ◽  
Tumor Phenotype

Abstract Background Introducing neoadjuvant chemotherapy (NCT) in a breast cancer patient may be associated with changes in estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth hormone receptor 2 (HER2) status. Method In our prospective cohort study, we evaluated the impact of change in estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth hormone receptor 2 (HER2) on the prognosis of breast cancer patients treated with neoadjuvant chemotherapy (NCT). We investigated 110 patients with locally advanced breast cancer for ER, PR and HER2 status of their lesions before and after NCT. Result For hormone receptor status (HR) (which include ER, PR) of the residual tumor of the patients after receiving NCT, 12 (10.9%) of them changed from HR (+) to HR (−) and 15 (13.6%) changed from HR (−) to HR (+). For HER2 status after NCT, 8 (7.3%) patients changed from HER2 (+) to HER2 (−) and 9 (8.2%) patients changed from HER2 (−) to HER2 (+). Triple negative (TN) tumor phenotype changes occurred in 17 (15.5%) patients. Patients for whom the HR status changed from positive to negative had poor prognosis for both disease-free survival (DFS) and overall survival (OS) in univariate survival analysis. Conclusion Changes in ER, PR, HER2 status and tumor phenotype in breast cancer patients after NCT had a negative prognostic impact and were associated with a poor prognosis.

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