Bethesda Made It Clearer: A Review of 542 Patients in a Single Institution.

BACKGROUND: It is essential to interpret fine needle aspiration biopsy (FNAB) material correctly to create a common language among pathologists and surgeons, leading to a uniform approach to thyroid nodule management. We aimed to compare FNAB reports of patients at our institution who were treated with total thyroidectomy, before and after the Bethesda classification system. PATIENTS AND METHODS: Patients who underwent total thyroidectomy for thyroid nodules are reviewed. 226 patients who underwent total thyroidectomy before the Bethesda era (2006-2009) were classified as Group-I, and 316 patients in whom total thyroidectomy was performed after the Bethesda classification system was introduced (2010-2014) were classified as Group-II. RESULTS: Before Bethesda, 'nondiagnostic' or 'benign' lesions were reported in 16.4 and 45% of patients, respectively, which then significantly decreased to 4.7 and 32.9% as the Bethesda classification criteria came into use. In Group-II, the actual malignancy rates were 13.3, 2.8, 7.3, 15.5, 85.4, and 96.5% for Bethesda I, II, III, IV, V, and VI, respectively. CONCLUSION: Our experience confirms that the Bethesda classification system leads to a significant reduction in lesions that used to be reported as 'benign' without compromising the actual rates of malignancy. It ensures better classification of so-called suspicious lesions, and allows for more accurate predictions of suspicious or malignant lesions.

Wire-guided localization biopsy to determine surgical margin status in patients with non-palpable suspicious breast lesions.

PURPOSE: Guide-wire localization (GWL) has been a standard technique for many years. Excision of non- palpable malignant breast lesions with clear surgical margins reduces the risk of undergoing re-excision. The objective of the present study was to evaluate the efficacy of GWL biopsy for assessing surgical margins. METHODS: This retrospective study concerned 53 patients who underwent GWL biopsy for non-palpable breast lesions and breast carcinoma diagnosed by histological examination. Age of the patients, tumour size, radiographic findings, breast density specifications, specimen volumes, menopausal status and family history of the patients and surgical margin status were recorded. RESULTS: Median age was 53.3 years, median tumour size was 1.5 cm and median specimen volume was 71.5 cm3. In fifteen patients (28%) DCIS and in 38 patients (72%) invasive ductal carcinoma was diagnosed. There was positive surgical margins in twenty eight (52.8%) patients. The median distance to the nearest surgical margin was 7.2 mm in clear surgical margins. Younger age and denser breast specifications were found as statistically significant factors for surgical margin status. Median age of the patients who had positive margins was 49.4 years where it was 56.9 years in the patients with negative margins (p=0.04). 79% of the patients with positive margins had type 3-4 pattern breast density according to BIRADS classification as compared to 48% in the patients who had negative margins (p=0.03). Some 38 patients who had positive or close surgical margins received re-excision (72%). CONCLUSION: Positive margin rates may be higher because of inherent biological differences and diffuse growth patterns in younger patients. There are also technical difficulties that are relevant to denser fibroglandular tissue in placing hooked wire. High re-excision rates must be taken into consideration while performing GWL biopsy in non-palpable breast lesions.

Application of sentinel node biopsy in breast cancer patients with clinically negative and positive axilla and role of axillary ultrasound examination to select patients for sentinel node biopsy.

PURPOSE: To evaluate the identification rate and the false-negative (FN) rate of sentinel lymph node biopsy (SLNB) using preoperative axillary ultrasound (AU) in patients with clinically negative and positive axilla and to prove that SLNB could also be performed in clinically axillary positive patients. METHODS: Three hundred and fifty seven consecutive T1-2 invasive breast cancer patients with clinically negative or positive axilla were enrolled in our Institution between 2006 and 2011. All patients had preoperative AU, and underwent SLNB followed by breast conserving surgery or mastectomy with level 1, 2 axillary dissection. SLNB was performed using 5 mL of 1% methylene blue. The identification (ID) rate and the FN rate of SLNB were calculated for patients with clinically negative and positive axilla, and for patients with negative AU. RESULTS: Two hundred thirty two patients (65%) were clinically axillary-negative and 125 (35%) were clinically axillary-positive. The ID rates of SLNB were 91 and 89% and the FN rates were 7 and 9%, respectively, in patients with clinically negative and positive axilla. The ID rate of SLNB increased to 94% and the FN rate decreased to 4% after the exclusion of 85 patients (24%) with metastatic lymph nodes on AU. CONCLUSION: SLNB can be safely applied to T1 tumors regardless of the clinical status of the axilla. Use of AU before SLNB significantly increases the ID rate and decreases the FN rate of SLNB in clinically axillary negative as well as in positive patients.