Comparison of basal-like triple-negative breast cancer defined by morphology, immunohistochemistry and transcriptional profiles.

Basal-like invasive breast cancer is an important clinical group because of its association with a triple-negative phenotype defined by the lack of expression of estrogen, progesterone and human epidermal growth factor receptors 2, relative lack of therapeutic options and poor prognosis. However, depending on the method used to define these lesions, morphological assessment, immunohistochemical markers or gene expression, a different set of tumors is captured. The aim of this study was to investigate the consequences of using different methodological approaches to define basal-like lesions among triple-negative breast carcinomas with regard to their clinicopathological features and patient outcome. The cohort consisted of 142 invasive breast cancers with a triple-negative receptor status. First, each was reviewed histologically and those with morphological basal-like features were characterized as 'Path-Basal'. Second, the 'Core Basal' immunohistochemical lesions, defined as cytokeratin 5/6 and/or epidermal growth factor receptor 1 positive, within the triple-negative breast cancers were identified, and third their classification based on gene expression profiling was retrieved and those in the molecular 'PAM50 basal-like' subtype recorded. A total of 116 basal-like breast cancers were identified among the 142 triple-negative breast cancers by at least one of these three classifications (80%), but only 13 samples were defined as basal-like with all three methods. None of these 13 tumors were associated with lymphovascular invasion. The 34 morphological 'Path-Basal' lesions were significantly associated with a lack of nodal metastases. Comparing the estimates of death in the three classifications, the highest risk of death was seen for the 'Core Basal' group. In this study, we highlight that the definition of basal-like breast cancer based on different methodologies varies significantly and does not identify the same lesions. This incomplete overlap of cases emphasizes the need for consistent or new approaches to improve precise identification.

Epitheliosis, infiltrating epitheliosis, and radial scar.

The lesion termed "infiltrating epitheliosis" (IE) by Azzopardi is described using his original criteria. The differential diagnosis from radial scar (RS) is discussed. It appears that IE and RS are histologically and histogenetically different and are also associated with a different risk of carcinoma. IE can be associated with either in situ or invasive carcinoma, whereas RS being more like a process of involution is very seldom involved by a carcinoma. Therefore, whatever name is used among the several found in the literature, it should be made clear they are not interchangeable when reporting on lesions like IE and RS.

Punçäo aspirativa por agulha fina de lesöes mamárias usando dispositivo de auto-vácuo / Fine needle aspirations of breast lesions using auto-vacuum dispositive

Um novo dispositivo no qual uma mola é adaptada entre a seringa e seu êmbolo (dispositivo de auto-vácuo), foi testado para auxiliar a punçäo aspirativa por agulha fina. Após resultados encorajadores em cobaias, o sistema de auto-vácuo foi avaliado inicialmente na punçäo de 42 pacientes com nódulos de mama. Destas, 36 apresentaram confirmaçäo histológica de malignidade (89 por cento) e 11 por cento de benignidade. A sensibilidade foi 97 por cento, especificidade 100 por cento, valor preditivo positivo 100 por cento, valor preditivo negativo 67 por cento e acurácia total de 97 por cento. Concluiu-se que o sistema de auto-vácuo pode obter boas amostras para citologia, além de facilitar o procedimento.