ABSTRACT
PURPOSE: Histopathological biomarkers guide breast cancer management. Testing histopathological biomarkers on both core needle biopsy (CNB) and surgical excision (SE) in patients who are treated with upfront surgery is unnecessary and costly if there is high concordance between the two. This study investigated the concordance between CNB and SE for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor-2 (HER2), tumor grade and Ki-67. METHODS: Histopathological biomarker information were retrospectively collected from preoperative CNB and SE on patients diagnosed with breast cancer through the BreastScreen Sydney West program over a four-year period between January 2017 and December 2020. Data were then analyzed to calculate percentage of agreement and concordance using kappa values for ER, PR, HER2, tumor grade and Ki-67. RESULTS: A total of 504 cases of invasive breast cancers were analyzed. There was substantial level of concordance for ER 96.7% (κ = 0.687) and PR 93.2% (κ = 0.69). Concordance for HER2 negative (IHC 0, IHC 1 +) or positive (IHC 3 +) tumor on CNB was 100% (κ = 1.00). Grade and Ki-67 showed moderate level of concordance, 72.6% (κ = 0.545) and 70.5% (κ = 0.453), respectively. CONCLUSION: ER, PR and HER2 show high level of concordance. CNB is reliable in determining histopathological biomarkers for ER, PR positive and HER2 positive or negative tumors indicating that retesting these on SE may not be necessary.
Subject(s)
Breast Neoplasms , Biomarkers, Tumor/analysis , Biopsy, Large-Core Needle , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Female , Humans , Ki-67 Antigen , Receptor, ErbB-2 , Receptors, Estrogen , Receptors, Progesterone , Retrospective StudiesABSTRACT
Intestinal volvulus is a rare complication following laparoscopic surgery. We present the case of a young boy who had developed a small bowel obstruction following laparoscopic appendicectomy for perforated appendicitis. He had no evidence of any congenital malrotation on initial laparoscopy, yet was subsequently found to have a midgut volvulus requiring emergency laparotomy. No resection was required and subsequent convalescence was uncomplicated. This case highlights the importance of recognition of this uncommon but potential early complication of laparoscopy that warrants urgent surgical intervention.
