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Can additional immunohistochemistry staining replace the surgical excision for the diagnosis of papillary breast lesions classified as benign on 14-gage core needle biopsy?
MedLine Citation:
PMID:  23292118     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
To evaluate whether the upgrade-to-malignancy rate of benign papillary lesions on ultrasonographically (US)-guided 14-gage core needle biopsy (CNB) can be decreased using immunohistochemistry staining (IHC) for pathologic diagnosis, and to determine whether additional IHC can replace surgical excision for the diagnosis of papillary breast lesions classified as benign on 14-gage CNB. A total of 274 consecutive papillary lesions were studied, including available imaging findings, CNB specimens and surgical specimens. Two rounds of retrospective review of the pathologic slides from CNB were performed by a pathologist, including H&E staining (first round; 1R, n = 274) and IHC of the benign papillomas (second round; 2R). The upgrade-to-malignancy rate was assessed for benign papillomas with comparison between 1R and 2R. The final diagnosis was based on surgical pathology. The clinicoradiologic findings were compared between the benign and malignant papillomas at the time of final diagnosis. In 1R, 204 benign papillomas were identified. During 2R using IHC, three carcinomas and ten atypical papillomas were diagnosed. Among the 204 benign papillomas from 1R, 15 were found to be carcinomas (upgrade-to-malignancy rate, 7.4 %) at the time of final diagnosis. With 2R, the overall upgrade-to-malignancy rate was decreased to 4.7 % (9/192, p = 0.3680). Older age and upgrades made after IHC review resulted in higher upgrade-to-malignancy rates (odds ratio, 4.133, 95 % CI 1.393-12.267, p = 0.0106; 134.46, 95 % CI 17.886-infinity, p < 0.0001, respectively). The use of IHC may decrease the upgrade-to-malignancy rate for benign papillary lesions after US-guided 14-gage CNB and help to more accurately predict malignancy at the time of surgery. Despite these findings, a misdiagnosis still occurred in our study, suggesting that IHC cannot replace surgical excision for diagnosis of benign papillary lesions of the breast.
Authors:
Ja Seung Koo; Kyunghwa Han; Min Jung Kim; Hee Jung Moon; Eun-Kyung Kim; Byeong-Woo Park
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-6
Journal Detail:
Title:  Breast cancer research and treatment     Volume:  -     ISSN:  1573-7217     ISO Abbreviation:  Breast Cancer Res. Treat.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8111104     Medline TA:  Breast Cancer Res Treat     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea.
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