Naoya Gomi

Endoscopic classification of intraductal lesions and histological diagnosis

BackgroundTo diagnose intraductal lesions endoscopically the Japanese Association of Mammary Ductoscopy classified the endoscopical appearance of lesions into three types. We investigated the correlation between endoscopic classification and histological diagnosis.MethodsFrom April 1998 to February 2001, we enrolled 129 female patients who were diagnosed histologically and whose intraductal lesions were detected by mammary ductoscopy. The endoscopic classification consists of three types. The polypoid type is a localized expansive lesion. This type is divided into two subtypes, the solitary subtype (solitary polypoid lesion) and the multiple subtype (multiple polypoid lesions). The combined type is polypoid lesion(s) coexisting with a superficial type. The superficial type is a superficial spreading lesion such as a continuous luminal irregularity accompanied by no obvious elevations.ResultsThere were 65 cases of breast cancer and 64 cases of benign papillary lesions. Fifty-four cases of benign papillary lesions and 7 cases of breast cancer were classified as the polypoid-solitary type. Seven benign cases and 13 cases of cancer were classified as the polypoid-multiple type. Two benign cases and 16 cases of cancer were classified as the combined type. Only one benign case and 29 cases of cancer were classified as the superficial type. There is significant correlation between endoscopical types and the histological diagnosis (p < 0.0001).ConclusionsEndoscopic classification is useful to diagnose intraductal lesions.

Influence of Lymphatic Invasion on Locoregional Recurrence Following Mastectomy: Indication for Postmastectomy Radiotherapy for Breast Cancer Patients With One to Three Positive Nodes

PURPOSE The indication for postmastectomy radiotherapy (PMRT) in breast cancer patients with one to three positive lymph nodes has been in discussion. The purpose of this study was to identify patient groups for whom PMRT may be indicated, focusing on varied locoregional recurrence rates depending on lymphatic invasion (ly) status. METHODS AND MATERIALS Retrospective analysis of 1,994 node-positive patients who had undergone mastectomy without postoperative radiotherapy between January 1990 and December 2000 at our hospital was performed. Patient groups for whom PMRT should be indicated were assessed using statistical tests based on the relationship between locoregional recurrence rate and ly status. RESULTS Multivariate analysis showed that the ly status affected the locoregional recurrence rate to as great a degree as the number of positive lymph nodes (p < 0.001). Especially for patients with one to three positive nodes, extensive ly was a more significant factor than stage T3 in the TNM staging system for locoregional recurrence (p < 0.001 vs. p = 0.295). CONCLUSION Among postmastectomy patients with one to three positive lymph nodes, patients with extensive ly seem to require local therapy regimens similar to those used for patients with four or more positive nodes and also seem to require consideration of the use of PMRT.

Breast cancer associated with mammary hamartoma

Mammary hamartoma is an infrequent, nonmalignant lesion. Only 12 cases of carcinomas associated with a hamartoma have been previously documented in the literature. We describe a case of invasive ductal carcinoma arising in the mammary hamartoma during the follow-up period of a previously diagnosed hamartoma.

Endoscopic and Histologic Findings of Intraductal Lesions Presenting with Nipple Discharge

Abstract:  To improve the utility of mammary ductoscopy, we investigated the correlation between endoscopic findings and histologic findings using intraductal biopsy specimens. Seventy‐one intraductal biopsy specimens obtained from 63 patients between October 2001 and March 2004 were analyzed retrospectively. All specimens were obtained from monotonous intraductal lesions immediately after observation by mammary ductoscopy and were composed of a pure histologic subtype. With regard to endoscopic findings, color was classified as yellow, red, white, or colorless, and morphology was classified as spherical, lobular, mulberry, or amorphous. The histologic subtype was classified as papillotubular, papillary, degenerated, papillary cancer, solid‐type ductal carcinoma in situ (DCIS), or cribriform cancer. The relationship between histologic diagnosis, color, and morphology was investigated. Intraductal biopsy specimens included 25 specimens of carcinoma and 46 specimens of papilloma. There was no significant correlation between color and diagnosis. Fourteen of 25 carcinoma specimens were amorphous, and amorphous morphology was significantly suggestive of malignancy (p < 0.001). Further, cribriform cancer was associated with amorphous morphology and yellow color. Morphology may be a useful endoscopically delineated parameter for differentiating intraductal lesions. 

What is the Predictor for Invasion in Non-palpable Breast Cancer with Microcalcifications?

PurposeTo assess the presence of invasion in non-palpable breast cancer with microcarcifications.Material and MethodsWe investigated 157 patients with non-palpable breast cancer with microcalcifications, who had undergone stereotactic core biopsy or vacuum-assisted breast biopsy and operation at the Cancer Institute Hospital between 1995 and 2001. We investigated the correlation between the area of calcification (maximum range of microcalcifications measured in mm by direct mammograhy), morphology of calcification on mammography, histological subtype of intraductal carcinoma (comedo or non-comedo) and frequency of invasion, and lymph node metastasis. The chi-square test was used in the statistical analysis andp values less than 0.05 were considered statistically significant.ResultsInvasion was observed in 33 of 157 pts (21%), of whom 23 showed minimal invasion, which is less than 0.5 cm in greatest diameter. The risk of invasion was 13% within 10 mm of the microcalcifications (n = 70), 25% from 11 to 30 mm (n = 59), and 32% more than 31 mm from the microcalcifications (n = 28). The risk of invasion was 16% for punctate-round and amorphous type (n = 87) microcalcifications, and 27% for pleomorphic and linear-branching types (n = 70) (p = 0.092). In addition, invasion was found 10% of the time within 10 mm of punctate-round and amorphous type microcalcifications, and 20% of the time at 11 mm or more. On the other hand, invasion was found 15% of the time within 10 mm of pleomorphic and linear-branching type microcalcifications, and 37% of the time at 11 mm or more. In 72 cases of intraductal carcinoma diagnosed by pathological examination, invasion was found in 10 of 31 (32%) comedo type intraductal carcinomas and in 5 of 41 (12%) non-comedo types(p = 0.0379). There were 5 cases (3.2%) with axillary lymph node metastasis, all of which widely extended more than 21 mm from the microcalcifications.ConclusionThe risk of invasion was 10% within 10 mm of punctate-round and amorphous type microcalcifications, and 37% at more than 11 mm of pleomorphic, linear-branching microcalcifications.

Surgical excision without whole breast irradiation for complete resection of ductal carcinoma in situ identified using strict, unified criteria

BACKGROUND The definition of complete resection of ductal carcinoma in situ (DCIS) is difficult to standardize because of the high variety of surgical breast conserving procedures, specimen handling, and pathological examinations. Using strictly controlled criteria in a single institute, the present study aimed to determine the ipsilateral breast cancer rate when radiotherapy is omitted following complete resection of DCIS. METHODS We retrospectively examined 363 consecutive DCIS patients who underwent breast-conserving surgery, and of these, 125 (34.4%) had complete resection according to the criteria. We finally included 103 patients who omitted radiotherapy. Ipsilateral and contralateral breast cancer events were assessed. RESULTS The median follow-up period was 118 months. The incidences of ipsilateral and contralateral breast cancer and ipsilateral invasive breast cancer at 10 years were 10.8%, 9.1%, and 3.6%, respectively. No patient died of breast cancer. CONCLUSION If complete resection of DCIS can be ensured, the annual incidence of ipsilateral breast cancer, even without irradiation, can be limited to approximately 1%, which equals the incidence of contralateral breast cancer.

Clear Cell Sarcoma of the Neck Which Metastasized to the Mammary Gland

Malignant neoplasms very rarely metastasize to the mammary gland, the incidence of which is reported as 0.5–2%. Clear cell sarcoma is a rare neoplasm, accounting for approximately 1% of all soft tissue tumors, which commonly occurs in the distal extremities of young adults aged approximately 20 to 40 years. So it is also called malignant melanoma of soft parts because it frequently produces melanin. We report a case of a 26-year-old woman who presented with a neck mass. The mass was surgically removed, and pathological diagnosis was clear cell sarcoma of the neck, harboring the EWS-ATF1 chimeric gene. Computed tomography detected a right breast mass 11 months after operation. She was referred to our department, and the right breast tumor was resected. Histopathological examination revealed a 2.5-cm, well-defined mass composed of nests of small, spindle-shaped tumor cells with abundant, clear cytoplasm containing round nuclei and prominent nucleoli. The tumor cells were immunohistochemically positive for HMB45, S-100, and Melan-A. These findings led to a diagnosis of metastasis of clear cell sarcoma to the mammary gland. This is the first report of clear cell sarcoma of the neck which metastasized to the mammary gland.

Invasive carcinoma of the breast accompanied by coarse calcification.

OBJECTIVE We describe the case of a woman with a left breast mass. At mammography, the mass was shown to be irregular and accompanied by coarse calcification. Core needle biopsy revealed invasive carcinoma and a mastectomy was performed. Histopathology showed fibrosis with partial hyalinization eccentrically placed within the tumor with a large area of calcification at the core. CONCLUSION Benign calcifications within a breast mass are not diagnostic of a benign process if the imaging characteristics of the mass are suspicious.

The accuracy of preoperative U.S.-guided vacuum-assisted breast biopsy (VABB) in determining ER, PgR, HER2, and Ki67 status in early breast cancer.

37 Background: The intrinsic subtypes are important in the management of patients with early breast carcinoma; however, there have been only a few reports about the accuracy of preoperative subtyping by the preoperative ultrasonography guided vacuum-assisted breast biopsy (U.S.-guided VABB). The aim of this study was to evaluate concordance of the status of ER, PgR, HER2, and Ki67 between U.S.-guided VABB and subsequent surgical specimen. METHODS We retrospectively assessed the concordance of ER, PgR, HER2 and Ki67 status between U.S.-guided VABB and surgical specimen. The patients (n=228) underwent surgical treatment without neoadjuvant chemotherapy at the institute of Japan Association of Breast and Thyroid Sonology (JABTS) Interventional study Group from 2009 to 2012. All the US-guided VABB were performed using 8 or 11-gauge Mammotome or 10-gauge VACORA. The ER and PgR status were determined by IHC and HER2 expression status was tested by both IHC and FISH. The agreement on ER, PgR, HER2 and Ki67 status were evaluated by the absolute concordance rate and the kappa statistic values. RESULTS The concordance rate of ER, PgR, and HER2 status between U.S.-guided VABB and surgical specimens were 96.4% (134/139), 89.2% (124/139), and 96.3% (130/135), respectively (kappa statistic value of 0.90, 0.77, and 0.84), and the agreement of Ki67 level was 89.6% (112/125) with a Kappa statistic value of 0.79. The concordance rate of the intrinsic subtypes was 84.0% (105 of 125 cases). CONCLUSIONS The judgment of ER status, and HER2 status by preoperative U.S.-guided VABB can be used with confidence to determine the treatment strategies based on molecular subtypes.