Satoko Nakano

Fibromatosis of the breast: A case report

We report a case of fibromatosis clinically suggestive of breast cancer, in which cancer treatment was prevented by fine needle aspiration (FNA) cytology. The patient was a 46-year-old Japanese woman who presented with nipple retraction of the left breast. Mammography demonstrated thickened nipple skin and an ill-defined, fairly dense tumor retracting the nipple. Ultrasonography showed an irregular hypoechoic tumor with a thick boundary echo and back echo attenuation. FNA was performed, and the aspirates consisted of isolated pleomorphic spindle cells showing large nuclei with fine chromatin and lacy cytoplasm, and papillary epithelial and myoepithelial cells. Thus an epithelial malignant tumor was ruled out. In this case, in which carcinoma was clinically strongly suspected and in which aspirates consisted of isolated pleomorphic spindle cells, fibromatosis should be considered to avoid unnecessary radical surgery.

Significance of Fine Needle Aspiration Cytology and Vacuum-Assisted Core Needle Biopsy for Small Breast Lesions

BACKGROUND In recent years, pathological diagnoses have been increasingly required, especially in small breast lesions, because malpractice lawsuits concerning erroneous cytological diagnoses have been commonly reported. Here, we retrospectively evaluated the significance of FNAC and VAB for small breast lesions using ultrasonography guidance. PATIENTS AND METHODS A total of 1383 cases for which ultrasonography-guided VAB was performed between June 1996 and December 2012 were reviewed. Of these, 455 small breast lesions (239 nonpalpable and 216 nonmass lesions) were included in the study. RESULTS Ultrasonography-guided FNAC was performed before VAB in 248 cases (54.5%). In 133 cases (53.6%), the results of FNAC were inconclusive. Pathological examinations using VAB revealed malignant and benign lesions in 199 and 256 cases, respectively. Of the 256 benign cases, we performed excisional biopsy in 17 cases (6.6%) and repeated VAB in 8 cases (3.1%). Excisional biopsy revealed malignant lesions in 2 cases. The reason for excisional biopsy was overdiagnosis using FNAC in 6 cases (35%). In all cases of repeated VAB, the pathological diagnosis was benign. The reason for repeated VAB was excision of the lesions in 5 cases (62.5%). The false positive and false negative rates of FNAC were 16.7% and 3.4%, respectively, whereas those of VAB were 0% and 1.0%, respectively. CONCLUSION Cytology findings for small breast lesions should be considered only when imaging and cytology indicate benign lesions. Therefore, pathological examination without cytological examination should be the initial approach.

Diagnostic imaging strategy for MDCT- or MRI-detected breast lesions: use of targeted sonography

BackgroundLeading-edge technology such as magnetic resonance imaging (MRI) or computed tomography (CT) often reveals mammographically and ultrasonographically occult lesions. MRI is a well-documented, effective tool to evaluate these lesions; however, the detection rate of targeted sonography varies for MRI detected lesions, and its significance is not well established in diagnostic strategy of MRI detected lesions. We assessed the utility of targeted sonography for multidetector-row CT (MDCT)- or MRI-detected lesions in practice.MethodsWe retrospectively reviewed 695 patients with newly diagnosed breast cancer who were candidates for breast conserving surgery and underwent MDCT or MRI in our hospital between January 2004 and March 2011. Targeted sonography was performed in all MDCT- or MRI-detected lesions followed by imaging-guided biopsy. Patient background, histopathology features and the sizes of the lesions were compared among benign, malignant and follow-up groups.ResultsOf the 695 patients, 61 lesions in 56 patients were detected by MDCT or MRI. The MDCT- or MRI-detected lesions were identified by targeted sonography in 58 out of 61 lesions (95.1%). Patients with pathological diagnoses were significantly older and more likely to be postmenopausal than the follow-up patients. Pathological diagnosis proved to be benign in 20 cases and malignant in 25. The remaining 16 lesions have been followed up.Lesion size and shape were not significantly different among the benign, malignant and follow-up groups.ConclusionsApproximately 95% of MDCT- or MRI-detected lesions were identified by targeted sonography, and nearly half of these lesions were pathologically proven malignancies in this study. Targeted sonography is a useful modality for MDCT- or MRI-detected breast lesions.

Successful use of multi-detector row computed tomography for detecting contralateral breast cancer.

Objective: We retrospectively evaluated whether multi-detector row computed tomography (MDCT) could contribute to the early detection of contralateral breast cancer in women with a diagnosis of breast cancer and no suspicious lesions on a mammogram or an ultrasonogram of the contralateral breast. Methods: A total of 518 women with newly diagnosed unilateral breast cancer underwent MDCT. Multi-detector row CT was performed using a 16-detector row CT scanner set for 2-mm collimation, 120 kilovolt (peak), and 180 mA. Axial images of the contralateral breast were evaluated. Results: Four hundred fifty-nine women were eligible for this study. There were suspicious malignant lesions only on MDCT in 21. Multi-detector row CT contributed to the diagnosis of contralateral occult breast cancer in 12 women (2.6%), including 1 in whom breast cancer was later diagnosed at another institution. Conclusions: Multi-detector row CT has a potential role in detecting contralateral breast cancer in women who are at high risk.

Differentiating vacuum-assisted breast biopsy from core needle biopsy: Is it necessary?

Needle biopsy has replaced excisional biopsy as a definitive diagnostic technique for breast tumours, although excisional biopsy is still used for complete tumour removal for therapeutic and/or diagnostic purposes. Many vacuum-assisted breast biopsy (VAB) systems have been made available by several manufacturers since the release of the Mammotome (MMT) by Johnson & Johnson in 1995. Several recent discussions have been conducted to identify whether core needle biopsy (CNB) or VAB, is more appropriate. However, currently available VAB systems differ from the conventional system (i.e. articulate arm type 11-gauge(G) MMT), and the characteristics of both CNB and VAB have been improved. In CNB, a 14-G needle is frequently used to obtain a larger sample. By contrast, VAB is considered easier to perform because it uses a thinner needle and a lighter, non-tethered system. When differentiating CNB from VAB, the type of VAB should also be defined. In this review, we discuss the characteristics of ultrasonography-guided VAB and CNB with a focus on practical issues such as the number of samples and volume of tissue obtained during ultrasonography-guided needle biopsy.

Spontaneous breast cancer remission: A case report.

Highlights • Spontaneous cancer remission without treatment is a known phenomenon with various types of cancer.• Although spontaneous breast cancer remission has been thought to be a rare, this may occurs at a certain rate(not rare phenomenon).• When cancer was not detected in the pathological specimen and there were no known biological markers to provide information for the decision regarding adjuvant therapy, observation without further treatment can be option.

Abstract P5-03-02: What is the optimal diagnostic approach for small breast lesions? Fine needle aspiration cytology vs. Vacuum-assisted core needle biopsy

[Background] Although advanced imaging technology enables us to detect small breast lesions, it remains a challenge whether it is a benign or malignant tumor with imaging findings alone. A definitive diagnosis is required with cytological or pathological diagnosis under ultrasonography guidance. Excessive examinations and malpractice are also concerned with increased examinations. The purpose of the study was to identify the optimal diagnostic approach for small breast lesions.[Patients and Methods] We reviewed a total of 1532 cases of ultrasonography-guided vacuum-assisted core needle biopsy (VAB) performed at a single institution between June 1996 and December 2013. There were 519 small breast lesions (274 non-palpable lesions and 245 non-mass lesions). Ultrasonographic examinations were performed on a LOGIC 500 (GE Healthcare, Waukesha, WI, USA) using an 11 MHz linear transducer before November 2011, and on Aplio MX (TOSHIBA, Minato, Tokyo, Japan) using an 8 MHz linear transducer since then. We performed VAB under ultrasonography guidance using 11-gauge probes (Mammotome Biopsy system; Biopsys Medical Inc., Irvine, CA, USA) for diagnosis and 8-gauge probes for excision of the lesion.[Results] The mean age of the 519 patients was 52.7 years. Ultrasonography-guided fine needle aspiration cytology (FNAC) was performed before VAB in 269 cases (51.8%). The FNAC revealed 76 malignant, 23 suspected malignant, 92 indeterminate, 47 benign or normal, and 31 inadequate cases. Of these FNAC results, the final pathological diagnosis was benign in 2 of 76 malignant and 6 of 21 suspected malignant cases, and malignant in 4 of 47 benign cases. Accordingly, the true positive, true negative, false positive, and false negative rates for the 146 cases (excluding the indeterminate and inadequate cases) by FNAC were 95.8%, 84.3%, 15.7%, and 4.2%, respectively. The pathological results of the VAB specimens were malignant in 229 and benign in 290 cases. Of the 290 cases classified as benign by VAB, we performed post-VAB excisional biopsy in 20 cases. The reasons for this second pathological examination were malignant or suspicious findings for malignancy by FNAC (8 cases), inconsistent imaging and FNAC findings (5 cases), and others (7 cases). Excisional biopsy revealed malignancy in 3 of these 20 cases. Furthermore, we re-performed VAB in 9 out of the original 290 cases, and these were all diagnosed benign as with the first VAB. Excision of the lesion was the primary reason for the second VAB (6 cases), followed by inconsistencies with the imaging findings (2 cases), and suspected malignancy by FNAC (1 case). The true positive, true negative, false positive and false negative rates of VAB were 98.7%, 100%, 0%, and 1.3%, respectively. The mean follow-up duration was 43 months. [Conclusion] To prevent the excessive examinations, FNAC should be excluded from the initial diagnostic approach for small breast lesions. VAB is a highly reliable technique as the initial diagnosis for small breast lesions with high true positive and true negative rates and a very low false positive rate. The optimal strategy for diagnostic procedures should be adopted in consideration of reducing stress and anxiety in patients and costs. Citation Format: Satoko Nakano, Masahiko Otsuka, Akemi Mibu, Toshinori Oinuma. What is the optimal diagnostic approach for small breast lesions? Fine needle aspiration cytology vs. Vacuum-assisted core needle biopsy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-03-02.