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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?
Breast Cancer Res Treat. 2013 Feb; 137(3):797-806.BC

Abstract

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+Show Affiliations

Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23292118

Citation

Koo, Ja Seung, et al. "Can Additional Immunohistochemistry Staining Replace the Surgical Excision for the Diagnosis of Papillary Breast Lesions Classified as Benign On 14-gage Core Needle Biopsy?" Breast Cancer Research and Treatment, vol. 137, no. 3, 2013, pp. 797-806.
Koo JS, Han K, Kim MJ, et al. Can additional immunohistochemistry staining replace the surgical excision for the diagnosis of papillary breast lesions classified as benign on 14-gage core needle biopsy? Breast Cancer Res Treat. 2013;137(3):797-806.
Koo, J. S., Han, K., Kim, M. J., Moon, H. J., Kim, E. K., & Park, B. W. (2013). Can additional immunohistochemistry staining replace the surgical excision for the diagnosis of papillary breast lesions classified as benign on 14-gage core needle biopsy? Breast Cancer Research and Treatment, 137(3), 797-806. https://doi.org/10.1007/s10549-012-2403-z
Koo JS, et al. Can Additional Immunohistochemistry Staining Replace the Surgical Excision for the Diagnosis of Papillary Breast Lesions Classified as Benign On 14-gage Core Needle Biopsy. Breast Cancer Res Treat. 2013;137(3):797-806. PubMed PMID: 23292118.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can additional immunohistochemistry staining replace the surgical excision for the diagnosis of papillary breast lesions classified as benign on 14-gage core needle biopsy? AU - Koo,Ja Seung, AU - Han,Kyunghwa, AU - Kim,Min Jung, AU - Moon,Hee Jung, AU - Kim,Eun-Kyung, AU - Park,Byeong-Woo, Y1 - 2013/01/06/ PY - 2012/10/16/received PY - 2012/12/24/accepted PY - 2013/1/8/entrez PY - 2013/1/8/pubmed PY - 2013/6/29/medline SP - 797 EP - 806 JF - Breast cancer research and treatment JO - Breast Cancer Res Treat VL - 137 IS - 3 N2 - 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. SN - 1573-7217 UR - https://www.unboundmedicine.com/medline/citation/23292118/Can_additional_immunohistochemistry_staining_replace_the_surgical_excision_for_the_diagnosis_of_papillary_breast_lesions_classified_as_benign_on_14_gage_core_needle_biopsy L2 - https://doi.org/10.1007/s10549-012-2403-z DB - PRIME DP - Unbound Medicine ER -