Breast core biopsy and therapeutic excision of
invasive breast carcinoma
Fourteen-gauge needle core biopsy of mammographically
Isolated bone marrow manifestation of Hodgkin lymphoma
associated with HIV
Diagnostic sensitivity of bronchoalveolar lavage
Breast core biopsy
and therapeutic excision of invasive
Breast core biopsy is a major nonoperative method of diagnosis.
Increasingly, there is also a need to provide prognostic data to
facilitate timely patient management. The authors presented the
results from 500 patients with invasive breast carcinoma who underwent
core biopsy followed by a therapeutic surgical procedure. Grade
and type of the invasive and in situ carcinoma, together with the
presence or absence of vascular invasion, were compared between
biopsy and definitive surgical excision. There was 67 percent agreement
with overall grade (kappa value, 0.48), with scores for tubule formation,
pleomorphism, and mitotic scoring achieving values of 82 percent,
73 percent, and 58 percent, respectively. Only 60 percent of grade
one and two carcinomas showed concordance, but 84 percent of grade
three tumors showed agreement between core and excision results.
Tumor typing, vascular invasion, and grading of ductal carcinoma
in situ had agreement values of 74 percent, 69 percent, and 65 percent,
respectively. The major problem with assessing prognostic factors
on needle biopsy specimens is undersampling of the most informative
areas. However, a high level of agreement was achieved in this study
in those patients in whom preoperative assessment of prognostic
factors is most likely to be beneficial—that is, those with
grade three carcinomas.
Harris GC, Denley HE, Pinder SE, et al. Correlation
of histologic prognostic factors in core biopsies and therapeutic
excisions of invasive breast carcinoma. Am J Surg Pathol.
Reprints: Dr. Gavin C. Harris, Dept. of Histopathology, Nottingham
City Hospital, Hucknall Rd., Nottingham, United Kingdom; email@example.com
core biopsy of mammographically evident radial scars
Radial scars are benign lesions that may mimic breast carcinoma
on mammography. They usually are managed by excision biopsy. The
authors reported their experience with stereotactic needle core
biopsy (SNCB) sampling compared to excision of the lesion in 75
patients. Sixty-three patients were sampled by core biopsy: SNCB
was used in 55 patients (87 percent) and ultrasound-guided needle
core biopsy (UNCB) was used in eight patients (13 percent). One
patient who underwent SNCB did not undergo a followup excision biopsy.
Radial scars were diagnosed preoperatively by core biopsy in 51
of 62 patients who underwent excision (82 percent; 95 percent confidence
interval, 70 to 91 percent). The sensitivity for SNCB was 85 percent
(95 percent CI, 73 to 94 percent), and the sensitivity for UNCB
was 63 percent (95 percent CI, 24 to 91 percent). Of 54 patients
who underwent SNCB and excision, four patients had coexistent ductal
carcinoma in situ (DCIS) at the time they underwent surgical excision:
SNCB identified DCIS in one patient and identified atypical ducal
hyperplasia in three patients. In the group of 75 radial scars,
five (seven percent) were associated with DCIS, and there were no
invasive carcinomas. Atypical ductal hyperplasia was present in
association with 42 of 74 radial scars (57 percent) that were excised
surgically. Twenty-nine of the radial scars were sampled preoperatively
by SNCB. Atypical ductal hyperplasia was found in 21 patients (72
percent; 95 percent CI, 53 to 87 percent). These findings suggest
that patients with SNCB-proven radial scars among a screened population
can be managed safely by mammographic followup if there is no associated
DCIS, atypical ductal hyperplasia, or lobular carcinoma in situ.
Spiculated abnormalities with discordant SNCB results require surgical
Cawson JN, Malara F, Kavanagh A, et al. Fourteen-gauge
needle core biopsy of mammographically evident radial scars. Is excision
necessary? Cancer. 2003;97;345-351.
Reprints: Jennifer N. Cawson, Breast Screen Department, St. Vincent's
Hospital, First Floor, Healy Wing, 41 Victoria Parade, Fitzroy 3065,
Victoria, Australia; firstname.lastname@example.org
Isolated bone marrow
manifestation of Hodgkin lymphoma associated with HIV
Human immunodeficiency virus-associated Hodgkin lymphoma frequently
involves bone marrow and is usually recognized at staging after
Hodgkin lymphoma diagnosis on a lymph node or other tissue biopsy.
Occasionally, however, marrow involvement is the only apparent manifestation
of disease, and diagnosis can be problematic. Of 42 patients with
newly diagnosed human immunodeficiency virus-associated Hodgkin
lymphoma, 22 subjects had positive marrow involvement at diagnosis,
and 16 of them had additional substantial histological or clinical
extramedullary Hodgkin lymphoma. In the remaining six patients,
bone marrow was the only site of disease at diagnosis. In all six
cases, bone marrow biopsy revealed obvious lymphomatous involvement.
Reed-Sternberg cells were identified morphologically and immunophenotypically
in all cases. Spared marrow tissue consistently showed fibrosis.
All of the study subjects were males (median age, 35 years; range,
31 to 58 years), and all presented with fever, blood cytopenias,
and severe CD4+ lymphocyte depletion (median, 70 cells/mm3).
After diagnosis, all staging procedures were negative, and all patients
were treated with chemotherapy. Median survival was four months
(range, two to 118 months). Longer survival occurred in the patients
who completed chemotherapy regimens; three subjects, however, died
shortly before completing chemotherapy, two of them from Hodgkin
lymphoma. The occurrence of isolated bone marrow HIV-associated
Hodgkin lymphoma may be underestimated in HIV-infected patients.
In those people with unexplained fever and blood cytopenias, bone
marrow biopsy should be performed with the aim of assessing for
Hodgkin lymphoma, even in the absence of nodal and visceral lymphomatous
involvement. A rapid diagnosis of isolated bone marrow HIV-associated
Hodgkin lymphoma could expedite therapy.
Ponzoni M, Fumagalli L, Rossi G, et al. Isolated
bone marrow manifestation of HIV-associated Hodgkin lymphoma. Mod
Reprints: Dr. Maurilio Ponzoni, Dept. of Pathology and Infectious
Diseases, S. Raffaele H Scientific Institute, Via Olgettina 60,
20132 Milan, Italy; email@example.com
of bronchoalveolar lavage vs. lung
Bronchoalveolar lavage and lung fine-needle aspirate are commonly
performed as the first line of investigation for a myriad of pulmonary
problems associated with abnormal imaging findings, including mass,
cavitary lesion, and infiltrates. The relative sensitivities of
these two procedures are not well established for cytologic diagnosis
of lesions for any single disease event. Between January 1989 and
June 2000, 52 episodes of closely timed (65 percent within three
days) bronchoalveolar lavage (BAL) and lung fine-needle aspirate
(LFNA) procedures were identified in 45 patients for a single disease
event. The clinical scenarios as per the sample requisitions were:
consolidation/infiltrate (60 percent), mass/nodule (23 percent),
cavitary lesion (5.7 percent), pneumonia (5.7 percent), or not specified
(5.7 percent). In 18 of the 52 pairs (35 percent), LFNA uniquely
identified malignancy (12 percent) or infectious agents such as
Aspergillus and acid-fast bacteria (23 percent) with a corresponding
nondiagnostic BAL. In one episode with a clinical diagnosis of infiltrates,
the BAL was positive for acid-fast bacteria and the LFNA was negative.
Chi-square analysis of the data revealed statistical significance
(P<.0001), indicating LFNA to be a better method than BAL
for the cytologic diagnosis of pulmonary pathology.
Clark BD, Vezza PR, Copeland C, et al. Diagnostic
sensitivity of bronchoalveolar lavage versus lung fine needle aspirate.
Mod Pathol. 2002:15(12):1259-1265.
Reprints: Dr. Andrea Abati, Cytopathology Section, Laboratory
of Pathology/NCI/ NIH, Bldg. 10, Room 2A19, Bethesda, MD 20892-1500;