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Immunohistochemistry increases the accuracy of diagnosis of benign papillary lesions in breast core needle biopsy specimens.
Histopathology. 2006 May; 48(6):683-91.H

Abstract

AIMS

Recent studies have suggested that benign papillary lesions without atypia [benign papilloma (BP)] diagnosed on breast core needle biopsy (CNB) may not require excision. However, most have studied only small numbers of cases and scant data are available on the utility of immunohistochemistry in the categorization of papillary lesions on CNB. In the largest published series of BP identified on CNB, we studied the impact of immunohistochemistry on the accuracy of a CNB diagnosis of BP.

METHODS AND RESULTS

Breast CNBs (n = 129) with a diagnosis of papillary lesion were immunostained for calponin, p63 and cytokeratin 5/6. Haematoxylin and eosin and immunostained slides were independently reviewed by four breast pathologists. BP was the final excision diagnosis in 35 cases. With the use of immunohistochemistry, the positive predictive value (PPV) of BP diagnosis by the four individual pathologists increased from 72.7-83.3% (mean 79.2%) to 77.8-87.5% (82.1%), the negative predictive value (NPV) increased from 77.8-98.5% (88.6%) to 100% for all four participants and overall accuracy increased from 78.7-92.6% (84.7%) to 90.7-95.4% (92.8%). No case of invasive carcinoma was diagnosed as BP on CNB by any participant. The frequency of ductal carcinoma in situ following a BP diagnosis on CNB ranged from 2.5% to 4.8% (4%) but was only 0-3% (2.3%) after excluding cases that were radiologically suspicious for malignancy.

CONCLUSIONS

Immunohistochemistry increases accuracy of BP diagnosis in CNB specimens. Benign papillary lesions diagnosed on CNB do not require excision in the absence of suspicious clinical/radiological findings.

Authors+Show Affiliations

Radiology, Singleton Hospital, Swansea, UK. varsha.shah@gwent.wales.nhs.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16681684

Citation

Shah, V I., et al. "Immunohistochemistry Increases the Accuracy of Diagnosis of Benign Papillary Lesions in Breast Core Needle Biopsy Specimens." Histopathology, vol. 48, no. 6, 2006, pp. 683-91.
Shah VI, Flowers CI, Douglas-Jones AG, et al. Immunohistochemistry increases the accuracy of diagnosis of benign papillary lesions in breast core needle biopsy specimens. Histopathology. 2006;48(6):683-91.
Shah, V. I., Flowers, C. I., Douglas-Jones, A. G., Dallimore, N. S., & Rashid, M. (2006). Immunohistochemistry increases the accuracy of diagnosis of benign papillary lesions in breast core needle biopsy specimens. Histopathology, 48(6), 683-91.
Shah VI, et al. Immunohistochemistry Increases the Accuracy of Diagnosis of Benign Papillary Lesions in Breast Core Needle Biopsy Specimens. Histopathology. 2006;48(6):683-91. PubMed PMID: 16681684.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Immunohistochemistry increases the accuracy of diagnosis of benign papillary lesions in breast core needle biopsy specimens. AU - Shah,V I, AU - Flowers,C I, AU - Douglas-Jones,A G, AU - Dallimore,N S, AU - Rashid,M, PY - 2006/5/10/pubmed PY - 2006/7/13/medline PY - 2006/5/10/entrez SP - 683 EP - 91 JF - Histopathology JO - Histopathology VL - 48 IS - 6 N2 - AIMS: Recent studies have suggested that benign papillary lesions without atypia [benign papilloma (BP)] diagnosed on breast core needle biopsy (CNB) may not require excision. However, most have studied only small numbers of cases and scant data are available on the utility of immunohistochemistry in the categorization of papillary lesions on CNB. In the largest published series of BP identified on CNB, we studied the impact of immunohistochemistry on the accuracy of a CNB diagnosis of BP. METHODS AND RESULTS: Breast CNBs (n = 129) with a diagnosis of papillary lesion were immunostained for calponin, p63 and cytokeratin 5/6. Haematoxylin and eosin and immunostained slides were independently reviewed by four breast pathologists. BP was the final excision diagnosis in 35 cases. With the use of immunohistochemistry, the positive predictive value (PPV) of BP diagnosis by the four individual pathologists increased from 72.7-83.3% (mean 79.2%) to 77.8-87.5% (82.1%), the negative predictive value (NPV) increased from 77.8-98.5% (88.6%) to 100% for all four participants and overall accuracy increased from 78.7-92.6% (84.7%) to 90.7-95.4% (92.8%). No case of invasive carcinoma was diagnosed as BP on CNB by any participant. The frequency of ductal carcinoma in situ following a BP diagnosis on CNB ranged from 2.5% to 4.8% (4%) but was only 0-3% (2.3%) after excluding cases that were radiologically suspicious for malignancy. CONCLUSIONS: Immunohistochemistry increases accuracy of BP diagnosis in CNB specimens. Benign papillary lesions diagnosed on CNB do not require excision in the absence of suspicious clinical/radiological findings. SN - 0309-0167 UR - https://www.unboundmedicine.com/medline/citation/16681684/Immunohistochemistry_increases_the_accuracy_of_diagnosis_of_benign_papillary_lesions_in_breast_core_needle_biopsy_specimens_ L2 - https://doi.org/10.1111/j.1365-2559.2006.02404.x DB - PRIME DP - Unbound Medicine ER -