scholarly journals Diagnosis of Intracystic Papillary Carcinoma of the Breast by Preoperative Core Needle Biopsy: A Case Report

2017 ◽  
Vol 102 (3-4) ◽  
pp. 119-124 ◽  
Author(s):  
Keiichi Takahashi
Keyword(s):  
Lymph Node ◽  
Papillary Carcinoma ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Preoperative Diagnosis ◽  
Preoperative Imaging ◽  
Axillary Lymph ◽  
Core Needle ◽  
Intracystic Papillary Carcinoma ◽  
Solid Part

Intracystic papillary carcinoma (ICPC) of the breast is rare. It is categorized as noninfiltrating papillary ductal carcinoma in situ (DCIS). It protrudes and grows into the inner cavity in a papillary form, usually unaccompanied by severe infiltration in the surrounding interstitium. ICPC is often a noninfiltrating carcinoma and differentiating it from benign intracystic papilloma is difficult using preoperative imaging alone. Therefore, deciding on a treatment policy is often difficult. For correct diagnosis, it is vital to perform fine needle aspiration (FNA) or core needle biopsy (CNB) of the intracystic solid part accurately and under ultrasound guidance. However, the rate of accurate diagnosis by FNA cytology is low, and diagnosis by CNB is reported to be more effective than cytology. CNB of the solid part of a cyst for preoperative diagnosis is difficult and has a sensitivity of 60%. There is also a report stating that preoperative diagnosis could not be obtained in 40% of patients with ICPC. Therefore, biopsy by resection should be considered in patients who cannot be diagnosed by either FNA or CNB. However, DCIS had better be preoperatively diagnosed because not only axillary lymph node dissection but also sentinel lymph node biopsy might be omitted. The patient was a 42-year-old woman. She found a tumor mass in the left inner breast 10 weeks before her initial visit to the author's clinic. It was difficult to differentiate between the benignity or malignancy of the tumor from images, but a diagnosis of ICPC was made using preoperative CNB.

scholarly journals A Rapidly Enlarging Squamous Inclusion Cyst in an Axillary Lymph Node following Core Needle Biopsy

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Cunxian Zhang ◽  
Jinjun Xiong ◽  
M. Ruhul Quddus ◽  
Joyce J. Ou ◽  
Katrine Hansen ◽  
...  
Keyword(s):  
Lymph Node ◽  
Core Needle Biopsy ◽  
Axillary Lymph Node ◽  
Needle Biopsy ◽  
Axillary Lymph ◽  
Inclusion Cyst ◽  
Epithelioid Cells ◽  
Core Needle ◽  
Reactive Changes ◽  
Touch Preparation

A 73-year-old woman was found to have a 1.7 cm axillary mass, for which a core needle biopsy was performed. The specimen revealed fragmented squamous epithelium surrounded by lymphoid tissue consistent with a squamous inclusion cyst in a lymph node, but a metastatic squamous cell carcinoma could not be excluded. Within one month, the lesion enlarged to 5 cm and was excised. Touch preparation cytology during intraoperative consultation displayed numerous single and sheets of atypical epithelioid cells with enlarged nuclei and occasional mitoses, suggesting a carcinoma. However, multinucleated giant cells and neutrophils in the background indicated reactive changes. We interpreted the touch preparation as atypical and recommended conservative surgical management. Permanent sections revealed a ruptured squamous inclusion cyst in a lymph node with extensive reactive changes. Retrospectively, the atypical epithelioid cells on touch preparation corresponded to reactive histiocytes. This is the first case report of a rapidly enlarging ruptured squamous inclusion cyst in an axillary lymph node following core needle biopsy. Our case demonstrates the diagnostic challenges related to a ruptured squamous inclusion cyst and serves to inform the readers to consider this lesion in the differential diagnosis for similar situations.

Accuracy of Preoperative Ultrasound-Guided Axillary Lymph Node Core Needle Biopsy to Predict Axillary Lymph Node Involvement in Breast Cancer

2021 ◽  
Vol 104 (6) ◽  
pp. 964-968
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Core Needle Biopsy ◽  
Axillary Lymph Node ◽  
Needle Biopsy ◽  
Breast Cancer Surgery ◽  
Axillary Lymph ◽  
Ultrasound Guided ◽  
Core Needle ◽  
Preoperative Ultrasound

Background: Breast cancer operative management consists of breast surgery and axillary lymph node (ALN) assessment. ALN status is an important prognostic factor and determinant of breast cancer treatment. Objective: To investigate preoperative ultrasound-guided axillary lymph node core needle biopsy (USACNB) accuracy in predicting ALN involvement for breast cancer. Materials and Methods: This retrospective cohort study took place between February 2014 and May 2019. One hundred nine consecutive operable breast cancer patients with suspicious ALN involvement were assessed using preoperative USACNB and subsequent breast cancer surgery. Exclusion criteria were insufficient ALN tissue from USACNB for interpretation, previous breast or axillary surgery on the same side. Patients with preoperative histopathology results proving of metastasis underwent ALN dissection (ALND) while those with negative results had sentinel lymph node biopsy (SLNB). When SLNB was positive, ALND was then performed. Preoperative USACNB accuracy was analyzed using SLNB or ALND pathological results as standard tests. Results: The sensitivity, specificity, PPV, and NPV of preoperative USACNB in evaluating ALN involvement was 87.5%, 100%, 100%, and 80.4%, respectively, with an accuracy of 91.7%. Conclusion: Preoperative USACNB shows high diagnostic accuracy in ALN metastasis, but its NPV remains too low to completely rule out ALN involvement. Standard SLNB is still necessary in cases of negative USACNB. Keywords: Breast cancer; Ultrasound guided core needle biopsy; Axillary lymph node

Risk of invasion and axillary lymph node metastasis in ductal carcinomain situ diagnosed by core-needle biopsy

2007 ◽  
Vol 94 (8) ◽  
pp. 952-956 ◽  
Author(s):  
P. Meijnen ◽  
H. S. A. Oldenburg ◽  
C. E. Loo ◽  
O. E. Nieweg ◽  
J. L. Peterse ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Axillary Lymph Node Metastasis ◽  
Axillary Lymph ◽  
Ductal Carcinomain Situ ◽  
Core Needle ◽  
Node Metastasis ◽  
Carcinomain Situ

scholarly journals Encysted Papillary Carcinoma of the Breast (EPC): A Follow-up Study to Investigate the Role of Sentinel Lymph Node Biopsy

2020 ◽  
pp. 178-182
Author(s):  
Ioannis Spyrou ◽  
Foivos Irakleidis ◽  
Stergios Douvetzemis ◽  
Hisham Hamed ◽  
Ashutosh Kothari
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Papillary Carcinoma ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Lymph Node Biopsy ◽  
Core Needle ◽  
Final Histology ◽  
Node Biopsy

Background: Encysted papillary carcinoma (EPC) is a rare breast neoplasm that mainly affects postmenopausal women. The purpose of this study was to examine whether a sentinel node biopsy would be deemed necessary in patients with a diagnosis of EPC and to determine if evidence of invasiveness can be diagnosed on a core needle biopsy with sufficient confidence to guide decision making for upfront axillary SLNB.Methods: The available data of patients with EPC of the breast were reviewed at a tertiary breast cancer unit over a period of 10 years (2009-2019) and the concordance between core needle biopsy and final histology was assessed. We also carried out a detailed review of the available literature to inform best practice guidance for management of the axilla. Results: During the study, a total of 37 EPC patients were identified, of whom 10 were excluded as they declined further treatment, providing us a study sample of 27 patients. The median age at diagnosis was 72 years (range 47-97) and the vast majority of patients (96%) were Estrogen Receptor (ER) positive. Of the 27 patients treated, 17 (63%) underwent a diagnostic axillary Sentinel Lymph Node Biopsy (SLNB). On the final histology, 13/27 (48%) proved to have invasive disease. A total of 5 (18%) patients had evidence of metastasis in the axillary nodes, of whom only 7% had macro-metastatic disease that warranted further axillary treatment. None of the treated patients had evidence of recurrence or distant metastatic disease, to date (median of 5 years of follow up).Conclusions: Encysted papillary carcinoma is associated with a low incidence of axillary node involvement. SLNB should only be carried out when there is evidence of invasive cancer. An algorithm was developed to help guide management of the axilla in cases diagnosed with EPC on diagnostic core needle biopsy.

Intracystic papillary carcinoma of the breast in a male patient diagnosed by core needle biopsy: a case report

The Breast ◽  
2005 ◽  
Vol 14 (4) ◽  
pp. 322-324 ◽  
Author(s):  
Takayuki Kinoshita ◽  
Takashi Fukutomi ◽  
Eriko Iwamoto ◽  
Miyuki Takasugi ◽  
Sadako Akashi-Tanaka ◽  
...  
Keyword(s):  
Case Report ◽  
Papillary Carcinoma ◽  
Male Patient ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Carcinoma Of The Breast ◽  
Core Needle ◽  
Intracystic Papillary Carcinoma

scholarly journals Encapsulated Papillary Carcinoma of the Breast: Imaging Features with Histopathologic Correlation

2020 ◽  
Vol 2 (6) ◽  
pp. 590-597
Author(s):  
Sarah E Bonnet ◽  
Gloria J Carter ◽  
Wendie A Berg
Keyword(s):  
Papillary Carcinoma ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Breast Imaging ◽  
Ductal Carcinoma ◽  
Imaging Features ◽  
Term Survival ◽  
Core Needle ◽  
Cystic Component

Abstract Encapsulated papillary carcinoma (EPC) is a rare, clinically indolent breast malignancy most common in postmenopausal women. Absence of myoepithelial cells at the periphery is a characteristic feature. Mammographically, EPC typically presents as a mostly circumscribed, noncalcified, dense mass that can have focally indistinct margins when there is associated frank invasive carcinoma. Ultrasound shows a circumscribed solid or complex cystic and solid mass, and occasional hemorrhage in the cystic component may produce a fluid-debris level; the solid components typically show intense washout enhancement on MRI. Color Doppler may demonstrate a prominent vascular pedicle and blood flow within solid papillary fronds. Encapsulated papillary carcinoma can exist in pure form; however, EPC is often associated with conventional ductal carcinoma in-situ and/or invasive ductal carcinoma, no special type. Adjacent in-situ and invasive disease may be only focally present at the periphery of EPC and potentially unsampled at core-needle biopsy. In order to facilitate diagnosis, the mass wall should be included on core-needle biopsy, which will show absence of myoepithelial markers. Staging and prognosis are determined by any associated frankly invasive component, with usually excellent long-term survival and rare distant metastases.

scholarly journals Necessity of sentinel lymph node biopsy in ductal carcinoma in situ patients: a retrospective analysis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Young Duck Shin ◽  
Hyung-Min Lee ◽  
Young Jin Choi
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Node Metastasis ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Ductal Carcinoma ◽  
Invasive Cancer ◽  
Total Mastectomy ◽  
Core Needle ◽  
Node Metastasis

Abstract Background Sentinel lymph node biopsy (SLNB) is unnecessarily performed too often, owing to the high upstaging rates of ductal carcinoma in situ (DCIS). This study aimed to evaluate the upstaging rates of DCIS to invasive cancer, determine the prevalence of axillary lymph node metastasis, and identify the clinicopathological factors associated with upstaging and lymph node metastasis. We also examined surgical patterns among DCIS patients and determined whether SLNB guidelines were followed. Methods We retrospectively analysed 307 consecutive DCIS patients diagnosed by preoperative biopsy in a single centre between 2014 and 2018. Data from clinical records, including imaging studies, axillary and breast surgery types, and pathology results from preoperative and postoperative biopsies, were extracted. Univariate analyses using Chi-square tests and multiple logistic regression analyses were used to analyse the data. Results The rate of upstaging to invasive cancer was 19.2% (59/307). DCIS diagnosed by core-needle biopsy (odds ratio [OR]: 6.861, 95% confidence interval [CI]: 2.429–19.379), the presence of ultrasonic mass-forming lesions (OR: 2.782, 95% CI: 1.224–6.320), and progesterone receptor-negative status (OR: 3.156, 95% CI: 1.197–8.323) were found to be associated with upstaging. The rate of sentinel lymph node metastasis was only 1.9% (4/202), and all were total mastectomy patients diagnosed by core-needle biopsy. SLNB was performed in 37.2% of 145 breast-conserving surgery patients and 91.4% of 162 total mastectomy patients. Among the 202 patients who underwent SLNB, 145 (71.7%) without invasive cancer on final pathology had redundant SLNB. Two of 59 patients (3.4%) with disease upstaged to invasive cancer had inadequate primary staging of the axilla, as the rate seemed sufficiently small. Conclusions In patients with a preoperative diagnosis of DCIS, although an unavoidable possibility of upstaging to invasive cancer exists, axillary metastasis is unlikely. Only 2.7% of patients with DCIS undergoing total mastectomy were found to have sentinel lymph node metastases. SLNB should not be performed in breast-conserving surgery patients and should be reserved only for total mastectomy patients diagnosed by core-needle biopsy.

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