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Breast Cancer Research and Treatment Apr 2019The second International Consensus Conference on B3 lesions was held in Zurich, Switzerland, in March 2018, organized by the International Breast Ultrasound School to... (Review)
Review
PURPOSE
The second International Consensus Conference on B3 lesions was held in Zurich, Switzerland, in March 2018, organized by the International Breast Ultrasound School to re-evaluate the consensus recommendations.
METHODS
This study (1) evaluated how management recommendations of the first Zurich Consensus Conference of 2016 on B3 lesions had influenced daily practice and (2) reviewed current literature towards recommendations to biopsy.
RESULTS
In 2018, the consensus recommendations for management of B3 lesions remained almost unchanged: For flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL) and radial scars (RS) diagnosed on core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB), excision by VAB in preference to open surgery, and for atypical ductal hyperplasia (ADH) and phyllodes tumors (PT) diagnosed at VAB or CNB, first-line open surgical excision (OE) with follow-up surveillance imaging for 5 years. Analyzing the Database of the Swiss Minimally Invasive Breast Biopsies (MIBB) with more than 30,000 procedures recorded, there was a significant increase in recommending more frequent surveillance of LN [65% in 2018 vs. 51% in 2016 (p = 0.004)], FEA (72% in 2018 vs. 62% in 2016 (p = 0.005)), and PL [(76% in 2018 vs. 70% in 2016 (p = 0.04)] diagnosed on VAB. A trend to more frequent surveillance was also noted also for RS [77% in 2018 vs. 67% in 2016 (p = 0.07)].
CONCLUSIONS
Minimally invasive management of B3 lesions (except ADH and PT) with VAB continues to be appropriate as an alternative to first-line OE in most cases, but with more frequent surveillance, especially for LN.
Topics: Biopsy, Large-Core Needle; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Carcinoma, Lobular; Databases, Factual; Female; Humans; Image-Guided Biopsy; Minimally Invasive Surgical Procedures; Phyllodes Tumor; Population Surveillance; Practice Guidelines as Topic
PubMed: 30506111
DOI: 10.1007/s10549-018-05071-1 -
Indian Journal of Ophthalmology Jun 2016Biopsy involves the surgical removal of a tissue specimen for histopathologic evaluation. Most intraocular tumors are reliably diagnosed based on the clinical evaluation... (Review)
Review
Biopsy involves the surgical removal of a tissue specimen for histopathologic evaluation. Most intraocular tumors are reliably diagnosed based on the clinical evaluation or with noninvasive diagnostic techniques. However, accurately diagnosing a small percentage of tumors can be challenging. A tissue biopsy is thus needed to establish a definitive diagnosis and plan the requisite treatment. From fine-needle aspiration biopsy (FNAB) to surgical excision, all tissue collection techniques have been studied in the literature. Each technique has its indications and limitations. FNAB has been reported to provide for 88-95% reliable and safe ophthalmic tumor diagnosis and has gained popularity for prognostic purposes and providing eye conserving treatment surgeries. The technique and instrumentation for biopsy vary depending upon the tissue involved (retina, choroid, subretinal space, vitreous, and aqueous), suspected diagnosis, size, location, associated retinal detachment, and clarity of the media. The cytopathologist confers a very important role in diagnosis and their assistance plays a key role in managing and planning the treatment for malignancies.
Topics: Biopsy; Eye; Eye Neoplasms; Humans; Neoplasm Staging
PubMed: 27488148
DOI: 10.4103/0301-4738.187652 -
Annals of Surgical Oncology Oct 2021Melanoma is the most lethal skin cancer. Excision biopsy is generally recommended for clinically suspicious pigmented lesions; however, a proportion of cutaneous... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Melanoma is the most lethal skin cancer. Excision biopsy is generally recommended for clinically suspicious pigmented lesions; however, a proportion of cutaneous melanomas are diagnosed by shave biopsy. A systematic review was undertaken to investigate the impact of shave biopsy on tumor staging, treatment recommendations, and prognosis.
METHODOLOGY
The MEDLINE, Embase, and Cochrane Library databases were searched for relevant articles. Data on deep margin status on shave biopsy, tumor upstaging, and additional treatments on wide local excision (WLE), disease recurrence, and survival effect were analyzed across studies.
RESULTS
Fourteen articles from 2010 to 2020 were included. In total, 3713 patients had melanoma diagnosed on shave biopsy. Meta-analysis revealed a positive deep margin in 42.9% of shave biopsies. Following WLE, change in tumor stage was reported in 7.7% of patients. Additional treatment was recommended for 2.3% of patients in the form of either further WLE and/or sentinel lymph node biopsy. There was high heterogeneity across studies in all outcomes. Four studies reported survival, while no studies found any significant difference in disease-free or overall survival between shave biopsy and other biopsy modalities.
CONCLUSIONS
Just over 40% of melanomas diagnosed on shave biopsy report a positive deep margin; however, this translated into a change in tumor stage or treatment recommendations in relatively few patients (7.7% and 2.3%, respectively), with no impact on local recurrence or survival among the studies analyzed.
Topics: Biopsy; Humans; Melanoma; Neoplasm Staging; Retrospective Studies; Sentinel Lymph Node Biopsy; Skin; Skin Neoplasms
PubMed: 33782802
DOI: 10.1245/s10434-021-09866-3 -
American Family Physician Aug 2013Thyroid nodules are a common finding in the general population. They may present with symptoms of pressure in the neck or may be discovered during physical examination....
Thyroid nodules are a common finding in the general population. They may present with symptoms of pressure in the neck or may be discovered during physical examination. Although the risk of cancer is small, it is the main reason for workup of these lesions. Measurement of thyroid-stimulating hormone can identify conditions that may cause hyperfunctioning of the thyroid. For all other conditions, ultrasonography and fine-needle aspiration are central to the diagnosis. Lesions larger than 1 cm should be biopsied. Lesions with features suggestive of malignancy and those in patients with risk factors for thyroid cancer should be biopsied, regardless of size. Smaller lesions and those with benign histology can be followed and reevaluated if they grow. The evaluation of thyroid nodules in euthyroid and hypothyroid pregnant women is the same as in other adults. Thyroid nodules are uncommon in children, but the malignancy rate is much higher than in adults. Fine-needle aspiration is less accurate in children, so more aggressive surgical excision may be preferable.
Topics: Adult; Biopsy, Fine-Needle; Child; Female; Humans; Male; Pregnancy; Pregnancy Complications, Neoplastic; Thyroid Nodule; Ultrasonography
PubMed: 23939698
DOI: No ID Found -
Modern Pathology : An Official Journal... Jan 2018Prostatic adenocarcinoma remains the most common cancer affecting men. A substantial majority of patients have the diagnosis made on thin needle biopsies, most often in... (Review)
Review
Prostatic adenocarcinoma remains the most common cancer affecting men. A substantial majority of patients have the diagnosis made on thin needle biopsies, most often in the absence of a palpable abnormality. Treatment choices ranging from surveillance to radical prostatectomy or radiation therapy are largely driven by the pathologic findings in the biopsy specimen. The first part of this review focuses on important morphologic parameters in needle biopsy specimens that are not covered in the accompanying articles. This includes tumor quantification as well as other parameters such a extraprostatic extension, seminal vesicle invasion, perineural invasion, and lymphovascular invasion. For those men who undergo radical prostatectomy, pathologic stage and other parameters are critical in prognostication and in determining the appropriateness of adjuvant therapy. Staging parameters, including extraprostatic extension, seminal vesicle invasion, and lymph node status are discussed here. Surgical margin status is also an important parameter and definitions and reporting of this feature are detailed. Throughout the article the current reporting guidelines published by the College of American Pathologists and the International Collaboration on Cancer Reporting are highlighted.
Topics: Adenocarcinoma; Biopsy, Needle; Ejaculatory Ducts; Guidelines as Topic; Humans; Male; Margins of Excision; Neoplasm Invasiveness; Neoplasm Staging; Prostate; Prostatectomy; Prostatic Neoplasms; Seminal Vesicles; Specimen Handling
PubMed: 29297497
DOI: 10.1038/modpathol.2017.167 -
World Journal of Surgical Oncology Jan 2022The degree of contamination of healthy tissue with tumor cells during a biopsy in bone or soft tissue sarcomas is clearly dependant on the type of biopsy. Some studies...
BACKGROUND
The degree of contamination of healthy tissue with tumor cells during a biopsy in bone or soft tissue sarcomas is clearly dependant on the type of biopsy. Some studies have confirmed a clinically relevant contamination of the biopsy tract after incisional biopsies, as opposed to core-needle biopsies. The aim of our prospective study was to evaluate the risk of local recurrence depending on the biopsy type in extremity and pelvis sarcomas.
METHODS
We included 162 patients with a minimum follow-up of 6 months after wide resection of extremity sarcomas. All diagnostic and therapeutic procedures were performed at a single, dedicated sarcoma center. The excision of the biopsy tract after an incisional biopsy was performed as a standard with all tumor resections. All patients received their follow-up after the conclusion of therapy at our center by means of regional MRI studies and, at a minimum, CT of the thorax to rule out pulmonary metastatic disease. The aim of the study was the evaluation of the influence of the biopsy type and of several other clinical factors on the rate of local recurrence and on the time of local recurrence-free survival.
RESULTS
One hundred sixty-two patients with bone or soft tissue tumors of the extremities and the pelvis underwent either an incisional or a core-needle biopsy of their tumor, with 70 sarcomas (43.2%) being located in the bone. 84.6% of all biopsies were performed as core-needle biopsies. The median follow-up time was 55.6 months, and 22 patients (13.6%) developed a local recurrence after a median time of 22.4 months. There were no significant differences between incisional and core-needle biopsy regarding the risk of local recurrence in our subgroup analysis with differentiation by kind of tissue, grading of the sarcoma, and perioperative multimodal therapy.
CONCLUSIONS
In a large and homogenous cohort of extremity and pelvic sarcomas, we did not find significant differences between the groups of incisional and core-needle biopsy regarding the risk of local recurrence. The excision of the biopsy tract after incisional biopsy in the context of the definitive tumor resection seems to be the decisive factor for this result.
Topics: Biopsy; Biopsy, Large-Core Needle; Extremities; Humans; Neoplasm Recurrence, Local; Pelvis; Prospective Studies; Retrospective Studies; Sarcoma; Soft Tissue Neoplasms
PubMed: 35016693
DOI: 10.1186/s12957-021-02481-2 -
Current Oncology (Toronto, Ont.) Nov 2022Vacuum-assisted breast biopsy (VABB) has been replacing excisional biopsy in the treatment of benign breast lesions. Complete surgical excision is still needed for the... (Review)
Review
Vacuum-assisted breast biopsy (VABB) has been replacing excisional biopsy in the treatment of benign breast lesions. Complete surgical excision is still needed for the lesions occasionally diagnosed with breast cancer after VABB. We aimed to characterize residual tumors after VABB and define a subset of patients who do not need surgical excision after VABB. From a retrospective database, we identified patients diagnosed with breast cancer after VABB guided with ultrasonography. Patients who underwent stereotactic biopsies were excluded. We reviewed clinicopathologic data and radiologic findings of the sample. We identified 48 patients with 49 lesions. After surgical excision, the residual tumors were identified in 40 (81.6%) lesions, and there was no residual tumor in nine (18.3%) patients. Imaging studies could not accurately locate residual tumors after VABB. A small tumor size on a VABB specimen was associated with no residual tumor on final pathology. However, residual tumors were identified in four (40%) of 10 lesions with a pathologic tumor size less than 0.5 cm. In conclusion, complete surgical excision remains the primary option for most of the patients diagnosed with breast cancer after VABB. Imaging surveillance without surgery should be carefully applied for selected low-risk patients.
Topics: Humans; Female; Breast Neoplasms; Retrospective Studies; Breast; Biopsy, Needle; Image-Guided Biopsy
PubMed: 36547148
DOI: 10.3390/curroncol29120734 -
Current Treatment Options in Oncology Jun 2004Merkel cell carcinoma is a rare cutaneous neoplasm most commonly affecting the head and neck of elderly white patients. Even with treatment, Merkel cell carcinoma has a... (Review)
Review
Merkel cell carcinoma is a rare cutaneous neoplasm most commonly affecting the head and neck of elderly white patients. Even with treatment, Merkel cell carcinoma has a strong propensity toward local recurrence, lymphatic spread, and distant metastasis. Because of its rarity and the subsequent lack of well-controlled clinical trials, no single standard of care exists for the treatment of this aggressive tumor. In our institution, primary lesions are excised with wide margins or by Mohs' micrographic surgery. After local removal, the excision site is treated locally with external radiation therapy. Sentinel lymph node mapping and biopsy are performed. Patients with tumor within a sentinel lymph node undergo lymph node dissection and radiation to the lymphatic basin. Adjuvant chemotherapy is offered to high-risk patients with local disease and to patients with metastases. Patients with distant metastases are treated with a combination of salvage chemotherapy and radiation therapy.
Topics: Carcinoma, Merkel Cell; Combined Modality Therapy; Humans; Lymphatic Metastasis; Sentinel Lymph Node Biopsy; Skin Neoplasms
PubMed: 15115648
DOI: 10.1007/s11864-004-0011-9 -
Asian Pacific Journal of Cancer... Nov 2022Papillary breast lesions and neoplasms (PBLs/Ns) are diagnostically challenging lesions in both core needle biopsy (CNB) and radiology.
BACKGROUND
Papillary breast lesions and neoplasms (PBLs/Ns) are diagnostically challenging lesions in both core needle biopsy (CNB) and radiology.
AIM
To determine the accuracy and upgrade rate of CNB and BI-RADS diagnosis of PBLs/Ns compared to final excision diagnosis and the factors linked to upgrade.
METHODS
The favored CNB diagnosis and BI-RADS category for 82 PBLs/Ns were assessed based on histopathology, myoepithelial marker immunohistochemistry, mammographic/ultrasonographic findings. The radiological findings were compared to the pathological diagnoses. The accuracies of CNB and BI-RADS were compared to the excision diagnosis of the corresponding PBLs/Ns. The upgrade rates to malignancy were evaluated for both CNB and BI-RADS.
RESULTS
The presence of solid, irregular masses in breasts with composition A/B with calcification in radiology was significantly associated with the diagnosis of suspicious/malignant CNB, and malignant excision specimens (p<0.05). CNB was more accurate (90%), sensitive and specific with high positive and negative predictive values than BI-RADS. Combined CNB/BI-RADS accuracy was 90.2%. Overall upgrade rate came up to 9.8%. Upgrade rates to carcinoma were 7.3% for CNB and 8.5% for BI-RADS. Factors linked to upgrade were the age, lesion-size, BI-RADS category 4A and C, and histopathological/radiological discordance. All the upgraded PBLs/Ns were diagnosed as benign lesions in CNB with present/focally present myoepithelial diagnosis reflecting a sampling error.
CONCLUSION
Up to 9.8% of PBLs/Ns diagnosed on CNB and BI-RADS undergo upgrading upon final excision, despite the high diagnostic accuracy. These evidences should be considered for final decision on whether to excise the lesion or not.
Topics: Humans; Female; Biopsy, Large-Core Needle; Radiology; Carcinoma; Breast; Breast Neoplasms
PubMed: 36444611
DOI: 10.31557/APJCP.2022.23.11.3959 -
Blood Dec 2022According to expert guidelines, lymph node surgical excision is the standard of care for lymphoma diagnosis. However, core needle biopsy (CNB) has become widely accepted... (Review)
Review
According to expert guidelines, lymph node surgical excision is the standard of care for lymphoma diagnosis. However, core needle biopsy (CNB) has become widely accepted as part of the lymphoma diagnostic workup over the past decades. The aim of this study was to present the largest multicenter inventory of lymph nodes sampled either by CNB or surgical excision in patients with suspected lymphoma and to compare their diagnostic performance in routine pathologic practice. We reviewed 32 285 cases registered in the French Lymphopath network, which provides a systematic expert review of all lymphoma diagnoses in France, and evaluated the percentage of CNB and surgical excision cases accurately diagnosed according to the World Health Organization classification. Although CNB provided a definitive diagnosis in 92.3% and seemed to be a reliable method of investigation for most patients with suspected lymphoma, it remained less conclusive than surgical excision, which provided a definitive diagnosis in 98.1%. Discordance rates between referral and expert diagnoses were higher on CNB (23.1%) than on surgical excision (21.2%; P = .004), and referral pathologists provided more cases with unclassified lymphoma or equivocal lesion through CNB. In such cases, expert review improved the diagnostic workup by classifying ∼90% of cases, with higher efficacy on surgical excision (93.3%) than CNB (81.4%; P < 10-6). Moreover, diagnostic concordance for reactive lesions was higher on surgical excision than CNB (P = .009). Overall, although CNB accurately diagnoses lymphoma in most instances, it increases the risk of erroneous or nondefinitive conclusions. This large-scale survey also emphasizes the need for systematic expert review in cases of lymphoma suspicion, especially in those sampled by using CNB.
Topics: Humans; Female; Biopsy, Large-Core Needle; Lymphoma; Lymph Node Excision; Lymph Nodes; Biopsy; Retrospective Studies; Breast Neoplasms; Multicenter Studies as Topic
PubMed: 35797472
DOI: 10.1182/blood.2022015520